Tiny Tat/Fine Line
Tattoo Consent Form
Client Information
Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Date
Phone Number
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
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 list 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 this procedure is a permanent change to my skin and body.
I allow my tattoo to be photographed and be used for LM Brow Studios portfolio and social media/website.
I agree that LM Brow 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 and using the aftercare kit provided to me by LM Brow Studio. Improper care could lead to unwanted results or risk of infection.
I indemnify and hold harmless LM Brow Studio against any claims, expenses, damages, and liabilities.
I confirm that the information I provided in this document is accurate and true.
Client Signature
Signed Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: