Consent Form

Isaac Green Tattoos Consent Form
Client Information
Name*

First NameLast Name
Birth Date (ID Required - 18+)*

DayMonthYear
Date
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol? Have you had either of these within the last 24 hours?*

YesNo
Are you pregnant or breastfeeding?*

YesNo
Have you eaten something substantial before your appointment?*

YesNo
Do you have any allergies? If yes, please state them below:
If yes, please identify the allergies.
Do you have any skin conditions?*

YesNo
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 and that tattoos carry a risk.
I allow my tattoo to be photographed and be used for Tattoo Shop portfolio showcased.
*

I understand that I need to take care of the tattoo by following the instructions provided to me and that if improper care is taken, it may result in the tattoo healing badly or causing an infection on the tattooed area.
I, First Name* Last Name* , give full consent to the tattooing of my skin to be carried out by Isaac Green. I understand that by signing this, I have consented to all the above and all the information provided is to the best of my knowledge.
Signed Date*

DayMonthYear
Date
Should be Empty:

Isaac Green Tattoos Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver