TATTOO CONSENT FORM
Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
DOB:
*
-
Day
-
Month
Year
Date
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency contact name:
*
Relationship to you:
*
Emergency contact phone number:
*
Please enter a valid phone number.
Please answer the following questions:
Have you ever received a tattoo before?
*
Yes
No
Have you eaten in the last 4 hours?
*
Yes
No
Have you consumed any alcohol in the last 24 hours?
*
Yes
No
Have you taken aspirin, ibuprofen or blood thinners in the last 24 hours?
*
Yes
No
Are you prone to fainting?
*
Yes
No
Are you prone to heavy bleeding?
*
Yes
No
Have you ever had an allergic reaction to any of the following?
*
Adhesive Bandage/ Tape
Lidocaine
Lanolin
Latex Rubber
Jewellery/ Metals
Topical alcohol
None of the above
Do you have any allergies? If yes, please specify:
Are you pregnant or breastfeeding?
*
Yes
No
Do you have any communicable diseases? (H.I.V, A.I.D.S, HEPITITIS)
*
Yes
No
Do you have any other conditions which might affect the healing of this tattoo?
*
Yes
No
TATTOO CONSENT & RELEASE | Please check the boxes to indicate that you have read, understood and agreed to each section.
To induce LAURENELLA BEAUTY to tattoo me and in consideration of its doing so, I hereby release the tattoo studio, the tattoo artist and any employees and associates thereof from all manner of liabilities, claims, actions and demands, in law or in equity, which I or my heirs have or might have now or hereafter by reason of complying with my request to have a tattoo procedure performed.
I understand that any employee or agent of this studio when performing a tattoo does not act in the capacity of a medical professional. The suggestions made by any employee or agent of the studio are not to be construed or substituted for advice from a medical professional.
I understand I will be tattooed using appropriate instruments and techniques. To ensure proper healing of my tattoo, I agree to follow the aftercare instructions outlined in the written tattoo aftercare instructions provided to me until healing is complete.
I assume full responsibility for aftercare and cleanliness as I have read and fully understand the aftercare instructions. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. This includes any tattoos on fingers/ hands/ palms/ feet & ears, as I have been duly informed that these areas are physiologically predisposed to the dropping out, fading and/or blurring of ink.
I willingly submit to these procedures with a full understanding of possible complications such as, but not limited to infection, allergic reaction, or rejection of the ink. Neither the artist nor the studio is responsible for the meaning/ spelling of the symbol or lettering that I have provided them or have chosen from flash design sheets.
I understand that by having this tattoo performed I am making permanent change to my body and no claims have been made regarding the ability to undo changes made.
Signature
*
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