Consent/ Request Form
Client Information
Name
*
First Name
Last Name
Age
*
Birth Date
*
/
Day
/
Month
Year
Date
Identification (ID)
*
Upload pictured ID here
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(such as licence/Passport)
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Phone Number
May communicate via WhatsApp/Txt regarding this form
Email
*
example@example.com
Emergency contact name
*
First Name
Last Name
Emergency contact phone number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical History
Do you have any allergies?
*
Yes, specify below
No
FEMALE ONLY: Are you pregnant or nursing?
Yes
No
Are you on any medication?
*
Yes, specify below
No
Do you have any skin conditions?
*
Yes, specify below
No
Do you consume alcohol?
*
Yes,
No
Do you smoke?
*
Yes,
No
Have you felt poorly within the last 14 days?
*
Yes, specify below
No
Are you afraid of needles?
*
yes
No
Are you prone to feeling light headed / fainting?
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Yes
No
Do you consider yourself as an anxious person?
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Yes
No
If any, tell us about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes to any of the above, specify here
Important information before considering to book
Tattooist Abilities
*
The tattooist Miça (pronounced Meesha) is an apprentice. Booking confirms you are happy with the work seen so far and understand work produced may not be at expert level. Depth and techniques are being continuously learnt, developed and improved with every piece. The trust and support shown so far has enabled growth and knowledge.
Booking fee (requested once this form is sent and approved)
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A non-refundable booking fee of £20 is required to secure all appointment dates. if you are booking a large piece, extra booking fee may be required.• Your booking fee goes towards the final cost of your tattoo. Booking fees not only covers securing a date, but also time dedicated to communications as well as designing, altering, preparing and materials used for printing and setting up.
Booking fees will be forefeited
*
Fail to show up for your appointment.• Cancel/reschedule with less than 48 hours’ notice.• Arrive more than 15 minutes late.• Change your design significantly after the consultation
Cancellation & Rescheduling
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You may cancel/reschedule once with at least 48 hours’ notice. Any less results in a new booking fee.
Pricing & Payments
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Final prices are based on size, detail, placement, and time required.• You’ll receive a quote after your consultation, if the design or session needs changing after you confirmed it was ok, a new booking fee is required. We accept payments by cash (preferred), bank transfer or card machine ( £2 fee)
Design Process
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Upon booking, send as much information needed for a smoother designing process. Flash designs can not be changed unless stated.Custom designs are created based on your ideas, please state if you give permissions for our input for extra ideas to add to your designs for a final piece. Inspirational images are welcome but will be altered to make it your own piece, avoiding copying other artists work.Design previews will be available before the appointment date to confirm final price or to make alterations. Major design changes requires a new booking fee
Touch Ups
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1 free touch up is offered within 3 months, especially due to building experience. Touch up charges may occur if the issue is due to client negligence (e.g., sun damage, picking scabs).The tattoo is on areas prone to fading (hands, feet, elbows, etc.).
Important Notices
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We reserve the right to decline tattooing if we believe it could pose a health risk or affect results. You must not be under the influence of alcohol or drugs. Doing so will result in a cancellation and loss of your booking fee. If during your appointment there is to be any behaviour that causes concern, including and not limited to inappropriate sexual mannerisms, you will be asked to leave without future completion of the tattoo and no future appointments.
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Acknowledgment and Waiver
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I am 18 years or over
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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 in the studio and online as advertisement
*
I acknowledge there are no refunds offered
*
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.
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I understand that I need to take care of the tattoo by following the instructions given to me by the Tattoo Shop.
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I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo.
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I confirm that the information I provided in this document is accurate and true.
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Tattoo Request
Please explain what tattoo you would like? (custom, flash, style, etc)
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Do you have images to show me?
Upload any reference image to help your vision. (Drawings, plans, screenshots, etc)
Drag and drop files here
Choose a file
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Please specify which colour? Black, coloured etc
*
What size would you like your tattoo?
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Where would you like it located?
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Please specify preferred days & times for your appointment.
*
Thank you. Please sign and date below confirming you are happy to go ahead and to submit your request. You will be contacted soon.
Client Signature
*
Signed Date
*
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Day
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Month
Year
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