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
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email
example@example.com
Artist Information
Artist's Name

First NameLast Name
Appointment date

MonthDayYear
Date
Artist Email
example@example.com
Brief description of tattoo and location:
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?

YesNo
FEMALE ONLY: Are you pregnant or nursing?

YesNo
Do you have a communicable disease?

YesNo
Do you have any allergies?

YesNo
Do you have any skin conditions?

YesNo
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.
I acknowledge that I have advised my artist if I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medicine which thins the blood.I acknowledge it is not possible for the representatives and employees of New Realm Tattoo to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body.I understand that any skin treatments, laser hair removal, cosmetic surgery, tanning beds, exposure to the sun or other skin altering procedures, may result in changes to my tattoo.
Acknowledgment and Waiver
I understand that this procedure is a permanent change to my skin and body.
I acknowledge that neither New Realm Tattoo or the artist offer refunds.
I agree that neither New Realm Tattoo or the artist have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo. I have advised both New Realm Tattoo and my artist of any known allergies.
I understand that I need to carefully follow the aftercare instructions given to me by New Real Tattoo and my artist. Failure to follow the aftercare instructions can lead to infection.
I indemnify, release and discharge New Realm Tattoo and my artist from any and all claims, expenses, damages, liabilities and legal actions arising from or connected to my tattoo and the procedure used in the application of my tattoo.
I confirm that the information I provided in this document is accurate and true.
Client Signature

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Signed Date

MonthDayYear
Date
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:

Use the photographs and videos on social networks, publications, portfolios, and/or displays.Do not take photographs and videos
Client Signature

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Signed Date

MonthDayYear
Date
Should be Empty:

Tattoo Consent Form

Client Information

Artist Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver

Photograph and Video Consent