Solitude Studio
Tattoo Consent Form
Client Information
Name (First and last pls!)
*
Age
*
Birth Date
*
-
Month
-
Day
Year
Phone Number
Format: (000) 000-0000.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province/ County
Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
*
Yes
No
If you have a Uterus: Are you pregnant or nursing?
*
Yes
No
No Uterus here
Do you have a communicable disease?
*
Yes
No
Do you have any skin conditions?
*
Yes
No
Any skin conditions you want me to be aware of ?(e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition(s).
Please inform of any necessary medical history (e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition(s).
Acknowledgment and Waiver
Please read all questions and sign when complete :)
Do you fully consent and understand to this procedure making a permanent change to your skin and body?
*
I understand that this procedure is a permanent change to my skin and body.
Do you consent for Solitude Studio to use photo/video of your tattoo for marketing purposes on social media platforms?
*
I allow my tattoo to be photographed and be used for the Artist's portfolio and social media accounts.
I do not consent.
Do you acknowledge that Solitude Studio does not offer refunds on tattoo services? This does not include coming in for touch up appointments and alterations agreed upon by the client and artist.
*
I acknowledge that the Tattoo Shop does not offer refunds.
Do you agree that Solitude Studio does not have a way of identifying any allergies the client may have to the elements or ingredients used for the tattoo, and can not be held liable in case of allergic reaction?
*
I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo, and will not be liable for any allergic reaction to elements or ingredients.
Do you understand that after you leave your tattoo appointment, it is up to you to take care of your tattoo? Further, it is up to you to decide to follow aftercare instructions and suggestions provided by the Tattoo Artist?
*
I understand that following my appointment, I take on full responsibility over the care of my tattoo, whether that be by following the instructions and suggestions given to me by the Tattoo Artist, or not.
Do you understand the possibility of getting an infection as a result of negligence and poor aftercare of your tattoo, and In which case, the Tattoo Artist will not be held liable?
*
I understand that I might get an infection if I don't take care of my tattoo, and that my Tattoo Artist will not be held liable in this case. It is my responsibility to prevent an infection by following aftercare instructions and taking care of my tattoo.
Are you aware of the inherent risks associated with getting a tattoo? Therefore, you fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring and difficulties in the detection of melanoma?
*
I understand and am aware of the potential risks associated with getting a tattoo.
Do you Acknowledge that you've been given adequate opportunity to read and understand this document and that it was not presented to you at the last minute? Furthermore, do you understand you're signing a legal contract waiving certain rights to recover damages against the Tattoo Artist?
*
I acknowledge that I have been given adequate opportunity to read and understand this document.
Do you waive and release - to the fullest extent permitted by law - the Tattoo Artist from all liability whatsoever, including but not limited to, any and all claims or causes of action that you, your estate, heirs, executors or assigns may have for personal injury or otherwise?
*
Yes, I waive and release.
Do you waive and release the Tattoo Artist of any direct and/or consequential damages, which result or arise from the procedure and application of your tattoo, whether caused by the negligence or fault of either the Tattoo Artist, or otherwise?
*
Yes, I waive and release.
Is the information you provided in this document accurate and true to the best of your knowledge and ability?
*
I confirm that the information I provided in this document is accurate and true.
By signing below, I acknowledge that I have read the agreement, I understand it and agree to be bound to it.
Signed Date
-
Month
-
Day
Year
Date
Thank you so much for taking the time to fill out this form!
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