Tattoo Release Consent Form

Tattoo Release Consent Form
Artist: Corinna Steiner

License Number: 2024020590

Vivid Ink Stl

13080 Tesson Ferry Rd, St Louis MO 63128
Client Information
Full Name

First NameLast Name
Age
Birthday

MonthDayYear
Date
Upload Valid Government Issued Identification

Cancelof
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like a quiet session? (We can always switch up during the session)
Preferred Pronouns
Photos are taken for artist to reference in regards to growth and development, but this how how my artist may use my photos outside of that:
Are you under the influence of drugs or alcohol?*
Are you pregnant or nursing?
Do you have a communicable disease? (HIV, Hepatitis, etc.)
Are you currently taking any medication that contains blood thinners or that weaken the immune system that fights infection?
Medical History (e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc)
If yes, please identify the condition. Some conditions like diabetes could affect the healing process
Allergies
Acknowledgment & Waiver
I acknowledge that I have ample opportunity to carefully examine the stencil and design to be tattooed on my body, I approve of the overall design and I understand that I have the opportunity to speak up, and if I proceed with the procedure then it is deemed correct and to my satisfaction upon being placed on my body and that it is my responsibility to communicate with my artist if any changes / repositioning is required prior to being tattooed.
If I am having previous work covered up or reworked from another artist, I acknowledge that my tattoo artist has no way to determine how much of the initial tattoo will show through and that we always recommend laser tattoo removal for darker, larger pieces. The artist will try their best to cover original tattoo but it will likely result in numerous sessions, and there is a chance your older tattoo may slightly show through especially if it had scarring.
Today's Date

MonthDayYear
Date
Signature
For Artist

Please refer to your artist for the fields below. You are free to submit once they are filled
Signature
Date

MonthDayYear
Date
Should be Empty:

Tattoo Release Consent Form

Client Information

Acknowledgment & Waiver

For Artist