Tattoo Client Information & Consent Form

Tattoo Client Information & Consent Form

Please complete this form to provide your information, disclose relevant health details, and give legal consent for your tattoo procedure.
Personal Information

Please provide your basic details.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Home Address

Please provide your home address details.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Upload ID Picture

Cancelof
Emergency Contact Information

Provide details of someone we can contact in case of emergency.
Emergency Contact Full Name

First NameLast Name
Relationship to You
Emergency Contact Phone Number

Area CodePhone Number
Women Only Medical Confirmation

Please confirm the following if you are a woman.
Are you currently pregnant or nursing?
Medical information

Please answer the following .
Consent and Acknowledgment - Additional
Do you have any allergies? If yes, please specify (Including latex/Any tattoo inks/Aloe Vera
Do you have any medical conditions we should be aware of? If yes, please specify. (Including Herpes, Hepatitis, HIV)
Do you have any skin sensitivities or skin conditions (e.g., Eczema, Psoriasis, Dermatitis)? If yes, please specify.
Are you currently taking any medications? (eg. Blood thinners)
If yes, please specify your medications
Consent and Acknowledgment

Please read the following carefully and provide your consent.
Do you consent to having photos of your tattoos only, taken and posted to social media?
Do you consent to other filming and content creation for social media posts?
Signature (Please sign below to provide your legal consent)
Should be Empty:

Tattoo Client Information & Consent Form

Personal Information

Home Address

Emergency Contact Information

Women Only Medical Confirmation

Medical information

Consent and Acknowledgment