Client Information
Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
Phone Number
Format: (000) 000-0000.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
*
Yes
No
FEMALE ONLY: Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
*
Yes
No
Do you have any skin conditions?
*
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, frec'kles, etc.)
If yes, please identify the condition.
Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
*
I understand that a tattoo is a permanent change to my body and may only be removed with a surgical procedure, which can be expensive and may leave scars.
*
I consent to have photographs of my tattoo taken for the purposes of Sweet Pea Ink’s portfolio, website, and social media.
*
I acknowledge that the Sweet Pea Ink does not offer refund.
*
I agree that the Sweet Pea Ink does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.
*
I understand that I need to take care of the tattoo by following the instructions given to me by Sweet Pea Ink.
*
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo.
*
I agree to release and forever discharge and hold harmless Sweet Pea Ink and its artists from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo or the procedure and conduct used to apply my tattoo.
*
I have read and understand this consent form. I confirm that the information provided is accurate and complete to the best of my knowledge. I am at least 18 years old and have provided valid identification.
Client Signature
*
Signed Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: