Stabarella Studios
Tattoo Consent Form
Client Information
Name
*
First Name
Last Name
Age
*
Birth Date
*
-
Month
-
Day
Year
Date
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
Name
*
First Name
Last 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
*
-
Month
-
Day
Year
Date
Artist Name
*
Design Description and Placement:
*
Tattoo Price
*
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
*
Yes
No
Do you have a communicable disease (i.e. Covid, Flu, Common Cold)?
*
Yes
No
FEMALE ONLY: Are you pregnant or nursing?
*
Yes
No
No, born male
Do you have any allergies?
*
No
Yes (fill out “Skin Conditions/Allergies” section)
Do you have or ever had any of the following? (Check all that apply)
*
Blood Borne Diseases (i.e. HIV/AIDS/Hepatitis etc)
Take blood thinners
Heart Conditions
Diabetes
Recently gave birth
None of these 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
*
I agree that I read all of the policies, done my research on the artist and asked all necessary questions prior to getting the tattoo. I also understand that if I use a card that there will be a card processing fee.
*
I understand that this procedure is a permanent change to my skin and body.
*
I understand that depending on tattoo placement (ex.fingers, hands, palms, feet etc.) could fade quickly and can require consistent touch ups that will result in a set up fee. Or ink could spread out causing blowouts. (Keep in mind that your job could also affect the outcome of the tattoo)
*
I understand that at any moment Stabarella Studios and its artists have the right to refuse service (for possible health concerns, being under the influence, behavior etc.)
*
I allow my tattoo to be photographed and be used for Stabarella Studios/Tattoo Artist portfolio showcased.
*
I acknowledge that the Stabarella Studios and artists will not offer refunds.
*
I agree that the studio/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 understand that I need to take care of the tattoo by following the instructions given to me by the artist.
*
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo. Once I have left the studio it is fully my responsibility to care for my tattoo properly. If I do not, I understand that the artist can refuse to touch up or fix the tattoo due to my negligence.
*
I agree to the touchup policy and aware of block out dates during the summer.
*
I release Stabarella Studios and artists against any harm, false claims, damages, and liabilities.
*
I confirm that the information I provided in this document is accurate and true.
Client Signature
*
Signed Date
*
-
Month
-
Day
Year
Date
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Tattoo Artist Only
Legal Name
*
First Name
Last Name
Legal Form of Indentification
*
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Artist Signature
*
Signature Date
*
-
Month
-
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Date
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