Tattoo Consent Form

Stabarella Studios

Tattoo Consent Form
Client Information
Name

First NameLast Name
Age
Birth Date

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Name

First NameLast Name
Relation to you
i.e. mother, father, sibling, spouse etc.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Appointment Info
Appointment/Today’s Date

MonthDayYear
Date
Artist Name
Design Description and Placement:
Tattoo Price
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
Do you have a communicable disease (i.e. Covid, Flu, Common Cold)?
FEMALE ONLY: Are you pregnant or nursing?
Do you have any allergies?
Do you have or ever had any of the following? (Check all that apply)

Other (please explain in Medical History)
Skin Conditions/Allergies (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If none, fill out with “N/A”
Please tell about your medical history (e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition. If no, please put “N/A”
Acknowledgment and Waiver
Client Signature
Signed Date

MonthDayYear
Date

Stabarella Studios