Tattoo Consent Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date

Appointment

Please list your emergency contact information.

Please list any allergies you may have. (Ink, latex, adhesives, medications?)

Are you pregnant or breastfeeding?

Do you have hemophilia or a blood-cutting disorder?

Do you have diabetes, heart conditions, or immune-system disorders?

Are you currently taking any blood thinner or others medications?

Do you have a history of fainting, seizures or epilepsy?

Do you have hepatitis, HIV, or other blood-borne illness?

Do you have low blood sugar or other conditions affecting healing?

Have you consumed alcohol or drugs within the last 8-12 hours?

Do you have any skin issues at the tattoo site?

INFORMED CONSENT & RISK ACKNOWLEDGMENT

I acknowledge that I have been informed of the inherent risks associated with tattooing, including but not limited to infection, allergic reaction, scarring, excessive bleeding, and potential complications during healing. I confirm that I have had the opportunity to ask questions and that all questions have been answered to my satisfaction. I understand that proper aftercare is critical to healing and that failure to follow aftercare instructions may result in complications. I accept full responsibility for my tattoo after leaving the studio.

RELEASE OF LIABILITY

I hereby release and forever discharge the tattoo artist and studio from any and all liability, claims, demands, or causes of action arising from the tattoo procedure, to the fullest extent permitted by New York State law. I certify that I am at least 18 years of age and that all information provided is truthful and accurate.

Signature

Upload your photo ID.