RUTHLESS INK
Consent & Release Form
Personal Information
Patron Full Name
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Tattoo Artist Name
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Tattoo Appointment Date
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Please check box to indicate that the information provided is accurate:
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The information provided above [Patron Full Name], [Tattoo Artist Name], and [Date (Tattoo Appointment)] is true and accurate.
Legal Consent
Please check box to indicate that you understand, agree, and consent:
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I, [Patron Full Name], hereby give consent to [Tattoo Artist Name]; Operating as a licensed tattoo artist at Ruthless Ink, to apply a tattoo on this day; [Date (Tattoo Appointment)]. In consideration of doing so, I hereby release {tattooArtist}, operating under Ruthless Ink, from all manners of liabilities, claims, actions, and demands in law, or in equity, which I or my heirs might bring now or hereafter, by reason of complying with my request of a tattoo.
Acknowledgements
Please check each box to indicate that you understand and agree:
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I fully understand that any employee of Ruthless Ink, when performing a tattoo, does not act in the capacity of a medical professional. The tattoo will be performed using appropriate techniques, instruments, and approved pigments.
I understand that it is my responsibility to follow the aftercare instructions given by my tattoo artist; to maintain the appearance of my tattoo, and moreso to ensure the proper healing of my new tattoo.
I understand that infections can occur, due to lack of proper hygiene and/or pigment sensitivities.
I understand that a tattoo may take several weeks to heal fully & properly.
I understand that any skin treatments (i.e.- laser hair removal, plastic surgery, tanning, etc.) or any other skin altering procedures, following my tattoo application, may result in an adverse change to the appearance of my tattoo.
I understand that I am making a permanent change to my body, and that no claims about the possibility of reversing these changes have been made or implied by Ruthless Ink, or any of its employees or artists.
*** Following consultation/ and or the initial design request; I have now looked over the tattoo design presented to me by my artist, *and have initialed the final design that I approve.
**I am aware that I CAN modify and change my design! This can be done at the time the stencil is applied – or any time prior to the application of the tattoo.
*In making any changes to the design presented to me at the time of the application appointment; I understand that decision can/ & will lengthen the time of my appointment. I may be requested to come back at another time to finish the tattoo in a second session - or even to have it rescheduled to another day. *Fees may also be applicable to significant changes to the original design/idea presented.
Medical History
Has a physician told you that you have Hepatitis?
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Yes
No
Do you have Diabetes?
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Yes
No
Do you have difficulty stopping bleeding?
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Yes
No
Do you take blood thinners?
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Yes
No
Do you have heart-related problems?
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Yes
No
Do you have high blood pressure?
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Yes
No
Have you consumed food in the last 2 hours?
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Yes
No
Have you consumed any alcoholic beverages in the last 8 hours?
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Yes
No
Are you pregnant or nursing?
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Yes
No
Do you have any known allergies? (e.g., tea tree oil, lavender, latex) List all that may apply:
*
Please list any other medical or health conditions that might affect the tattoo or healing process:
*
Please check each box to indicate that you understand and agree:
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I certify that all medical information I have provided in this form is true, complete, and accurate to the best of my knowledge. I understand that providing false or incomplete information may increase the risk of complications and affect the outcome of my tattoo.
Legal Agreement
By checking each box below, I confirm that I have read, understand, and agree to each statement:
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I have read this release form and confirm that all the information I have provided here is correct.
I understand that this is a release form, and I agree to be legally bound by it.
Obtaining this tattoo is by my own choice, and mine alone.
I certify that I am over the age of 18 years old (DOB):
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Patron Full Name
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Patron Signature
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Today's Date
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License / ID #
*
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*
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Format: (000) 000-0000.
Address
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