TATTOO CONSENT FORM

Tattoo Consent Form

Application for Tattoo & Release of Liability and Waiver to All Claims

12288 Westheimer Rd, Suite 390 Houston, TX 77077 sapphirestudiohtx.com
Client Information

Please fill out the information below to the best of your knowledge
Full Name*

First NameLast Name
Age*
Date of Birth*

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

Street Address

Street Address Line 2

CityState

Zip Code
Tattoo Description*
Please describe your tattoo in detail. Size, placement, color, etc
Body Location of Tattoo*
Ex: right forearm, left wrist, etc
Appointment Date and Time*
Date and time you, and your artist have agreed upon.
SabrinaAnthonyGuest
Health Questionnaire

Please select all that apply to you
AntibioticsMetalsSoapsLatexAlcoholCosmeticsAdhesivesPetroleumLanolin OilLidocaineShellfishNoneOther
HepatitisTuberculosisGonorrheaSyphilisHIV/AIDSHerpesStaphAuto-Immune DisorderAsthmaCOVID-19InfectionsNoneOther
Heart DiseaseHigh Blood PressureDiabetesCurrently Pregnant or BreastfeedingProne to FaintnessSkin Disease/RashEpilepsyHemophiliaProne to Scarring/KeloidsPsoriasisBlood ThinnersEczemaNoneOther
Emergency Name and Phone Number
(Optional)
Are you currently on any medication? Please list:*
(Ex. Antidepressants, Antibiotics, Antipsychotics, etc. If none, put NA)
YesNo
Acknowledgment and Waiver

By completing and signing this form, I acknowledge that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo from Sapphire Studio LLC (under InkFamous Tattoo Studios) , and that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth, and I agree as follows:
I agree
I agree
I agree
I agree
I agree
I acknowledge that I have advised my tattoo artist of any condition that might affect the healing of this tattoo. I do not have medical or skin conditions such as but not limited to: acne, scarring (keloid), aczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer.*

I agree
I agree
I agree
I agree
I agree
I agree
I agree
I agree
I agree
I agree
I agree
Signed Date*

MonthDayYear
Date
Client Signature*

Powered by Jotform SignClear
Photo ID*

We accept any federal ID such as a driver’s license, passport, identification card, or CHL. NO PAPER IDENTIFICATION IS ALLOWED.
Cancelof
If you have any questions at all, please feel free to reach out to us on any of our social media platforms or our email, info@sapphirestudiohtx.com.

We can't wait to tattoo you! 💖
Should be Empty:

Client Information

Health Questionnaire

Acknowledgment and Waiver