Wild Rose Tattoo
TATTOO CONSENT FORM
Client Information
For a service with Hannah Jade, BAP-TA-10231783
This is an intake form before a service, *not* a booking inquiry form.
Please check here to say you understand that this is a health screening form for the day of a scheduled tattoo, NOT a booking inquiry. Booking information is on our website!
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I understand .
Full Name
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First Name
Last Name
Pronouns
Age
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Date of Birth
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Month
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Day
Year
Date
Phone Number
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Area Code
Phone Number
Email
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example@example.com
Would you like to receive emails from Wild Rose about news and events?
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Yes
No
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-tattoo Questionnaire
Are you under the influence of drugs or alcohol? (If you mark yes to either of these, we cannot tattoo you.)
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Yes
No
Are you pregnant or nursing? (If you mark yes to either of these, we cannot tattoo you.)
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Yes
No
Do you have any symptoms of cold or illness such as cough, fever, congestion, shortness of breath, gastric upsets, etc? If yes, by filling this form I agree to also VERBALLY tell my artist about such conditions.
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If yes, please identify the condition.
Skin conditions in the area (e.g. Stretch marks, rashes, eczema, infection, psoriasis, moles, freckles, etc.) If yes, by filling this form I agree to also VERBALLY tell my artist about such conditions. Some of these conditions may require us to move the tattoo placement.
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If yes, please identify the condition.
Medications that may effect the tattoo or healing (e.g. Blood thinners, acne medications, antibiotics, anti-rejection drugs, etc.) If yes, by filling this form I agree to also VERBALLY tell my artist and have cleared it with my doctor that I am safe and able to be tattooed.
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If yes, please identify the condition.
Medical History (e.g. Auto Immune Disorders, Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.) If yes, by filling this form I agree to also VERBALLY tell my artist about such conditions and have cleared it with my doctor that I am safe and able to be tattooed.
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If no, type "no". If yes, please identify the condition.
Acknowledgment and Waiver
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I agree to not bring any guests without prior approval from my artist.
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I understand that this procedure is a permanent change to my skin and body.
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I agree to have eaten a protein rich meal no longer than two hours before my appt.
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I allow my tattoo to be photographed and shared on Hannah's and Wild Rose Tattoo's social media accounts.
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I acknowledge that Wild Rose Tattoo does not offer refunds.
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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 my artist.
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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 care of my tattoo.
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I indemnify and hold harmless Wild Rose Tattoo and the artists therein against any claims, expenses, damages, and liabilities.
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I understand that it is my responsibility to make sure any script in my tattoo is spelled correctly.
Front of current, government issued ID. (Driver's License/passport)
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Browse Files
Cancel
of
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I confirm that the information I provided in this document is accurate and true.
Signed Date
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Month
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Day
Year
Date
Client Signature
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Submit
Should be Empty: