Tattoo Consent Form

Name

First NameLast Name

Age

Birth Date

Date

Phone Number

Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you under the influence of drugs or alcohol?

FEMALE ONLY: Are you pregnant or nursing?

Have you eaten in the last four hours?

Do you have a communicable disease?

Do you have any skin conditions?

Other

Are you prone to heavy bleeding?

Are you prone to fainting?

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.

Type a question

l acknowledge that the sterilisation method used was explained to my full satisfaction. I had the opportunity to ask questions regarding this procedure. All questions were answered to my satisfaction. All equipment during the procedure was opened in front of me. I witness the disposal of the tattoo needle(s) into regulated sharps containers. Both written and verbal Tattoo Aftercare Instructions were provided to me. I have read this Tattoo Consent & Release Form and confirm that all the information I have given is correct.I understand that this is a release form and I agree to be legally bound by it.

Please upload a photo of your ID front and back

Client Signature

Signed Date

Date

Tattoo Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver