Tattoo Consent Form

Tattoo Consent Form

**DO NOT FILL OUT UNTIL YOU REACH THE DAY OF YOUR APPOINTMENT.**
Client Information
Name

First NameLast Name
Age
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Artist Information
Artist's Name

First NameLast Name
Appointment date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Artist Email
example@example.com
Brief description of tattoo and location:
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
FEMALE ONLY: Are you pregnant or nursing?
Do you have a communicable disease?
Do you have any allergies?
Do you have any skin conditions?
List all allergies and skin conditions a(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
Client Signature
Signed Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Photograph and Video Consent
By filling out this agreement I grant permission for photographs and videos to be taken of my tattoo on today’s date.
- I understand that photographs and videos taken of my tattoo during this session may be used, wholly or in part, on the internet, in any publication, portfolio, or display, or in any other print or electronic medium as this artist chooses, unless otherwise specified below.
- I confirm I am 18 years of age or older. I will make no monetary or other claim against this artist for use of the photographs and videos. I understand that my name may or may not be included/credited in any form of publication unless requested otherwise.
blanks
This is how my artist may use photographs and videos of my tattoo:
Client Signature
Signed Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Tattoo Consent Form

Client Information

Artist Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver

Photograph and Video Consent