Tattoo Client Consultation Form

Tattoo Client Consultation Form

one step closer to your new tattoo!
Appointment Date

DayMonthYear
Date
Hour MinutesAM/PM Option
Client Information
Name

First NameLast Name
Preferred Name
Date of Birth (must be 18+)

MonthDayYear
Date
Gender

Other
If other please explain further
Pronouns
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Consultation Notes

Please answer the below questions giving as much information as possible.
Tattoo Placement Location (e.g. Upper Arm, Ankle, Wrist)
Please describe the tattoo design you would like, providing as much detail as possible. You may also send reference photos via email or through my social media accounts.
Do you prefer a quiet session (minimal conversation) or are you happy to chat during your appointment?
Would you like to bring a person along to your appointment?
Any accessibility I should be aware of?
You are welcome to bring along any items for comfort such as headphones, stress ball or a fidget toy as these will not be provided.
Medical Questionnaire

Please answer honestly. This information is confidential and ensures your safety.
Do you have any allergies?
If you answered yes, please give allergy details.
Do you have any skin conditions? (e.g. eczema, psoriasis)
If you answered yes, please give skin condition details.
Have you received chemotherapy or radiation treatment within the last 12 months?
Please list any medications which you currently take or have taken within the last 6 months. If you do not take any medication, please type 'none'.
Medical Conditions
Do you have or have you ever had any of the following?
Pre-Procedure Information
Tattoos are permanent, with pigment implanted beneath the skin's surface. Hoever, clients should be aware that tattoos may still fade or change slightly over time due to enviromental factors and the natural behaviour of skin cells.

Before your procedure, please note:
- Immediately after treatment, the tattoo colour will appear much sharper and darker. As the skin heals, the pigment will soften and lighten to the intended shade. This healing process typically takes up to 10 days, though this varies from person to person.
- Alcohol, Aspirin, or Coumadin should be avoided for at least 48 hours before the procedure.
- No medication should be stopped without first discussing it with your GP.
- The skin in or around the treated area may appear red or swollen following the procedure; this is a normal part of the healing process.
A patch-test is required in the case of coloured inks being used for your chosen tattoo design.
I understand that following the pre-procedure advice detailed above will ensure the best possible results from my treatment.
Tattoo Procedure Information
Tattooing involves puncturing the skin's surface to deposit ink beneath it, which carries several potential risks that clients should be aware of before undergoing the procedure. Key risks associated with tattoos include:
- Allergic Reaction
- Infection at the site of the procedure
- Keloid or Scar Formation
- Blood Poisoning & Septicaemia
Clients choosing to have a procedure with Rachel Dunsmore can be assured that a strict code of practice is always followed to minimise risks and maintain the highest standards of hygiene. If you have any questions or concerns about the risks involved, these should be discussed with the tattoo artist before the procedure takes place.
Please read the following statements carefully:
- Touch-up procedures may be necessary. (A touch-up appointment can be booked free of charge within the first 6 months. After 6 months, touch-up appointments will incur a fee.)
- A maximum healing period of 4-6 weeks is to be expected.
- On rare occasions, the pigment may migrate under the skin.
- Treatment may be uncomfortable.
- Over time, the pigments can fade/blur due to environmental factors and the nature of human cells.
- Immediately after the procedure, the pigment can be significantly sharper and darker than the healed result.
- There may be an immediate or delayed allergic reaction to pigments. However, these are extremely rare.
- A negative allergy patch test result does not guarantee that you will not have an allergic reaction.
- Tattoo procedures cannot be performed on anyone under the age of 18.
- Tattoo procedures cannot be performed on anyone pregnant or nursing.
- Infections can occur if aftercare instructions are not followed correctly.
- There may be swelling and redness following the procedure.
- You may experience minor bleeding.
Your Consent Statement
- I hereby authorise Rachel Dunsmore to perform upon myself this Procedure(s). If any unforeseen condition arises in the course of this procedure(s), calling in the technician's judgment in addition to, or different from those now contemplated, I further request and authorise her to do whatever she deems advisable and necessary in the circumstances.
- I accept responsibility for determining the tattoo design as agreed during the course of my consultation.
- I understand that an allergy test does not guarantee that I will not have an allergic reaction to the pigment used.
- I fully understand and accept that non-toxic pigments are used during the procedure and that the immediate result achieved may fade over time & during healing.
- I have been informed that the highest standards of hygiene are met, and that sterile disposable needles and pigment containers are used for each client, procedure and visit.
- I understand and accept that I may need to return for a retouch procedure due to environmental factors and the nature of human cells.
- I understand that re-touch sessions may be required to maintain the best results, and when this is required varies from person to person depending on their skin characteristics.
- The result of the procedure is determined by several factors, including but not limited to: Medication, Skin Characteristics - (dry, oily, sun-damaged and thickness), Natural skin undertones - (blending with chosen pigment), and correctly following post-procedure and aftercare advice.
- Upon Completion of the procedure, there may be some swelling and redness of the skin, which will subside within 1-4 days; in some cases, bruising may occur. You may resume normal activities immediately following the procedure. However, using cosmetics, excessive perspiration and sun exposure to the affected area should be avoided.
- I have been advised that the true colour will be seen within 4-8 weeks after each procedure, and that the pigment may vary in colour according to skin tones, skin type, age and skin conditions. I understand that some skins accept pigment more readily than others, and no guarantee of an exact effect or colour can be given.
- To my knowledge, I do not have any physical, mental or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have the procedure done at this time. I am over 18 years of age. I am not pregnant. I am not under the influence of alcohol or drugs.
- Being of sound mind and body, I hereby release any and all responsibility. I accept any and all responsibility that might stem from my decision to have any procedure performed by Rachel Dunsmore.
- For the purpose of documentation, I also consent to the taking of photographs of the procedure(s) for record purposes and for use in presentation portfolios.
- I understand and give consent by signing this consent form that my personal details and records relating to my procedure will be retained on file by Rachel Dunsmore for a minimum period of 5 years from the date of signing before being destroyed; however, they will never be shared with any third parties.
Your Consent
I certify that I have read and fully understand the above consent and procedure permit; that the explanations therein referred to were made and I accept full responsibility for these and or other complications which may arise or result during or following the permanent tattoo procedures, which is to be performed at my request according to this consent and procedure permit. I have read and understood the above information.
Please tick the box to confirm
Client Name

First NameLast Name
Client Signature
Date

MonthDayYear
Date
Your Information

Your personal data will be used for processing by Rachel Dunsmore in accordance with current data protection legislation.

Your data will be retained on file by Rachel Dunsmore and will not be passed on to any third parties. Please confirm your consent to the use of your information as above.
Should be Empty:

Tattoo Client Consultation Form

Consultation Notes

Medical Questionnaire

Medical Conditions

Pre-Procedure Information

Tattoo Procedure Information

Your Consent Statement

Your Consent