Tattoo Consent Form
Client Information
Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
Age
*
Phone Number
*
Email
*
example@example.com
Appointment date
*
-
Month
-
Day
Year
Date
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, freckles, 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
blanks
*
Acknowledge all the information is true and accurate.
*
I understand that this procedure is a permanent change to my skin and body.
*
I allow my tattoo to be photographed and be used for Beautifully Morbid tattoos portfolio showcased.
*
I acknowledge that Beautifully Morbid Tattoos does not offer refund.
*
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.
*
I understand that I need to take care of the tattoo by following the instructions given to me by Beautifully Morbid Tattoos.
*
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 indemnify and hold harmless Beautifully Morbid Tattoos against any claims, expenses, damages, and liabilities.
*
I confirm that the information I provided in this document is accurate and true.
Client Signature
*
Parent Signature if under 18*
Signed Date
*
-
Month
-
Day
Year
Date
ID Photo upload
*
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