Consent Form

Full Name:*

First NameLast Name

Date of Birth:*

18+ Only

Phone Number:*

Please enter a valid phone number.

Email:*

example@example.com

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact:*

Emergency Contact Phone Number:*

Please enter a valid phone number.

Who is your tattoo artist today?*

Date of Service:*

Date

Description of tattoo you are receiving today:*

Include placement on body and general description.

Are you pregnant or nursing?*

YesNo

Do you have any skin conditions or transmissible diseases? (e.g. Hepatitis A, B & C, influenza, measles, etc. or Rashes, sun burn, eczema, psoriasis, scars, cold sores, etc.)*

Please provide any important medical history. (e.g. Any known allergies, Diabetes, Cardiovascular Disease, Epilepsy, Blood-related diseases, etc.)*

Have you taken or done any of the following below?*

Blood thinning medications (Aspirin, Ibuprofen, Alcohol, Coumadin, etc.) within 24 hours.Tanning Booth/Salon in the last 2 weeks.Accutane or prescription acne treatment within the last year.Taken antibiotics or any medications now or within the last 30 days.None

By checking this box, you agree that it is your responsibility to confirm the price of the tattoo and the artist assumes no responsibility for any misunderstanding in this regard.*

I agree.

By checking this box, I agree I do not have a mental impairment that may affect my judgement in getting the tattoo and am not under the influence of drugs or alcohol.*

I agree.

By checking this box, I acknowledge that the Tattoo Artist does not offer refunds.*

I agree.

By checking this box, I acknowledge that the Tattoo Artist does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.*

I agree.

By checking this box, I understand that this procedure is a permanent change to my skin and body.*

I agree.

By checking this box, I waive and release the Tattoo Artist from all liability, including but not limited to, any and all claims or causes of action that I may have for personal injury, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either the Tattoo Artist, myself or others.*

I agree.

By checking this box, I confirm that the information I provided in this document is true.*

I agree.

I release the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. Please let your artist know verbally if you do not consent to photos.*

I agree.No thank you, do not use my photographs for reproduction.

Do you have any other questions or concerns you’d like answered before signing your contract? We will address these questions before starting to ensure you have all the info you need before your tattoo.

The Tattoo Studio has given me the full opportunity to ask any question about the procedure and application of my tattoo and all of my questions have been answered to my satisfaction.*

I agree.

TATTOO AFTERCARE

Only use non-fragrant, anti-bacterial, gentle soap. Do not use bar soaps, they can harbor bacteria.

Always use clean hands when touching your tattoo.

24 HOURS AFTER YOUR APPOINTMENT

Remove your second skin under warm water, pulling the edge flat against your skin, softly, until it’s removed.

Wash your tattoo gently with clean hands, gentle soap and water.

Dry thoroughly and moisturize with a nice thin and even layer and clean hands.

CONTINUED

Continue washing and moisturizing your tattoo at least 2-3 times a day, especially when you wake up in the morning and before bed at night.

Moisturize consistently and as needed when skin is feeling flaky, itchy or peeling.

Do not peel your tattoo. Do not shave over the tattooed skin.

Wait at least 3 weeks to resume with normal lotions and sunblock.

IF YOU ENCOUNTER

Redness and itchiness spreading around the second skin patch, remove immediately and wash thoroughly with clean hands, gentle soap and water. This may indicate an allergy. If you start to experience more severe symptoms, please contact your immediate care provider or doctor as soon as possible.

Redness spreading away from the tattooed area, hot skin to the touch, or pain, contact your immediate care provider or doctor as soon as possible as this may indicate a sign of infection.

Redness and swelling around your physical tattoo is normal and can last about 2-3 days after your appointment.

RECOMMENDED PRODUCTS

Soaps: Gold Dial Soap, Dr. Bronners Castille Unscented Soap, Cetaphil Gentle Cleanser.

Moisturizers: A&D Ointment, Coconut Oil, Aquaphor, Lubriderm.

*DISCLAIMER: Please understand that how well you follow tattoo aftercare can affect its results. Everyone’s skin responds differently in the healing process. Please note that disregarding any of these recommendations will leave you at-risk for infection post-procedure and will affect the quality of your tattoo. The artist is not responsible if this occurs. Please contact your doctor for recommendations, care and treatment if you suspect infection.*

I acknowledge that I have received aftercare instructions and understand the importance of following them carefully. I am aware that not adhering to the aftercare guidelines may compromise my results. Proper aftercare is essential for optimal pigment retention and minimizing the risk of infection. I also understand that these instructions are available to me at lovelettertatt.com for future reference.*

I agree.

Please upload a picture of the front of your government issued ID similar to the image example above:*

The picture must be taken with the ID on a FLAT surface and in clear, good light so it is legible. Please no dark or blurry images.

Please upload a picture of the back of your government issued ID similar to the image example above:*

The picture must be taken with the ID on a FLAT surface and in clear, good light so it is legible. Please no dark or blurry images.

Signature*

Signature Date:*

Date

Tattoos at Love Letter Tattoo