Tattoo Consent Form

Tattoo Consent Form
Client Information
Name

First NameLast Name
Age
Birth Date

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:
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 skin conditions?

YesNo
Skin conditions (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
I understand that this procedure is a permanent change to my skin and body.
I allow my tattoo to be photographed and be used for Tattoo Shop portfolio showcased.
I acknowledge that the Tattoo Shop does not offer refund.
I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.
I understand that I need to take care of the tattoo by following the instructions given to me by the Tattoo Shop.
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking food care of my tattoo.
I indemnify and hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities.Other
I confirm that the information I provided in this document is accurate and true.Other
Client Signature
Signed Date

MonthDayYear
Date
Should be Empty:

Tattoo Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver