Tattoo Consent Form
Please fill out the form prior to booking.
Client Information
Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Date
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
Yes
No
Are you at least 18 years or older?
Yes
No
FEMALE ONLY: Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
Yes
No
Do you have any skin conditions?
Yes
No
Are you on blood thinners or have you had a recent surgery within the past 6 months?
Yes
No
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.
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I understand that this procedure is a permanent change to my skin and body.
I allow my tattoo to be photographed and be used for Tattoo Shop portfolio showcased.
I acknowledge that the Tattoo Shop does not offer refund.
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.
I understand that I need to take care of the tattoo by following the instructions given to me by the Tattoo Shop.
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking food care of my tattoo.
I indemnify and hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities.
Other
I confirm that the information I provided in this document is accurate and true.
Other
Client Signature
Signed Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: