Tattoo Consent Form

Tattoo Consent Form

Please fill out the form prior to booking.
Client Information
Name

First NameLast Name
Age
Birth Date

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
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?
Are you at least 18 years or older?
FEMALE ONLY: Are you pregnant or nursing?
Do you have a communicable disease?
Do you have any skin conditions?
Are you on blood thinners or have you had a recent surgery within the past 6 months?
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.
Acknowledgment and Waiver

Please upload a copy of your ID & also one for Minors.
File Upload

Cancelof
Other
Other
Client Signature
Signed Date

MonthDayYear
Date
Should be Empty: