Tattoo Consent Form

TATTOO CONSENT FORM
CLIENT INFORMATION
File Upload

Upload Photo of Driver's license
Cancelof
Age
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
Are you a minor, have you completed minor consent form?
Have you eaten anything today?
FEMALE ONLY: Are you pregnant or nursing?
Do you have a communicable disease?
Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify condition. If none, input "N/A"
Do you have any skin conditions?
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify condition. If none, input "N/A"
ACKNOWLEDGEMENT & WAIVER
Before signing and submitting form, please have artist input dates and lot information of needle cartridges.
Client Signature
Signed Date

MonthDayYear
Date
Should be Empty:

TATTOO CONSENT FORM