Happy Tatts LLC
Clayton Harpole - BAP-TA-10168336
Tattoo Consent Form
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
Placement on body
Tattoo Discriptipn
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
Latex allergy
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 am of 18yrs of age or older
Type a question
I understand that this procedure is a permanent change to my skin and body.
Type a question
I allow my tattoo to be photographed and be used for Tattoo Shop portfolio showcased.
Type a question
I acknowledge that the tattoo artist does not offer refund.
Type a question
I agree that the tattoo artist does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.
Type a question
I understand that I need to take care of the tattoo by following the aftercare instructions given to me by the artist.
Type a question
I confirm that I have been fully informed of the inherent risks of receiving a tattoo. These include, but are not limited to, the risk of infection, scarring, allergic reactions to pigments or aftercare products, and potential variations in design. Having been informed, I voluntarily agree to proceed with the tattoo procedure and assume all associated risks.
Type a question
I indemnify and hold harmless Happy Tatts LLC against any claims, expenses, damages, and liabilities, to the fullest extent permitted by law from any causes of action for personal injury, including but not limited to risks resulting from the tattoo procedure.
Type a question
I confirm that the information I provided in this document is accurate and true.
Submit photo of I.D.
*
Client Signature
*
Signed Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: