Nathan Smith consent form.

Tattoo consent form.
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Phone Number*
Emergency contact name and number *
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Placement of Tattoo on your body:*
Please write a description of your tattoo:*
Do you have any of the following conditions that may affect your ability to safely receive a tattoo? (Please check the box if applicable)Diabetes, heart conditions, skin conditions, blood clotting disorders, hepatitis or other infectious diseases, allergies, autoimmune diseases, pregnancy or breastfeeding, epilepsy, keloid scarring, or any other medical condition that may impact the tattooing process*

None of the above
I confirm that I am not under the influence of drugs, alcohol, or any other substances that may impair my judgment or coordination at the time of receiving this tattoo.*

I confirm
Are you on any medication?*
Please list any allergies?*
Please list any factors that could affect your healing process?
Ex: diseases, medications, etc
Informed Consent:

1. I, the undersigned, understand that getting a tattoo involves needles, ink, and the potential for pain, bleeding, and allergic reactions. I have been given the opportunity to ask questions about the tattoo process and have received satisfactory answers.

2. I confirm that I am over the age of 18 and legally permitted to receive a tattoo.

3. I acknowledge that I have provided accurate and complete health history information to the best of my knowledge. I understand that certain health conditions or medications may affect my ability to heal properly or increase the risk of complications. I accept responsibility for discussing any relevant health conditions with my tattoo artist.

4. I agree to follow all aftercare instructions provided by the tattoo artist and understand that failure to do so may result in infection or other complications.

5. I acknowledge that the tattoo process involves Pain, risk of infection, scarring, allergic reactions, or other side effects, and I voluntarily accept these risks.

6. I understand that tattoos are permanent, and I am satisfied with the design and placement of my tattoo. I agree to hold the artist and the tattoo studio harmless for any dissatisfaction with the final result.

7. I grant permission for photographs of my tattoo to be taken for promotional purposes, social media, or other
Client Acknowledgment:

By signing below, I acknowledge that I have read, understood, and agreed to all terms and conditions outlined in this form.
Please indicate your artist*

Nathan SmithOther
Photo of your ID
Date of Appointment*

MonthDayYear
Date
Client Signature*

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Tattoo consent form.

Pre-Procedure Questionnaire