Jillian Tattoo Consent Form

Jillian Tattoo Consent Form

@jill.jillian
Date*

MonthDayYear
Date
Legal Name*

First NameLast Name
Name you use
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Email*
example@example.com
Your Date of Birth*

MonthDayYear
Date
State License or ID Number*
Phone Number*

Area CodePhone Number
armlegtorso(chest or back)Other
Description of Tattoo*
Exact spelling of any script in tattoo
Acknowledgment

I acknowledge by signing this consent form that I have been given the full opportunity to ask any questions which I might have about obtaining a tattoo and that all of my questions have been answered to my full satisfaction. The tattoo artist will use new needles for the tattoo and provide care instructions once the tattoo is complete. I hereby release my tattoo artist and this studio from all liability, claims, actions, and demands in law, or in equity, which I may have by obtaining this tattoo. I also acknowledge I have truthfully and accurately answered the questions listed below
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
If yes, please specify below:
YesNo
YesNo
YesNo
If yes, please list below:
YesNo
YesNo
YesNo
If yes, please list:
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
If no, please remind your tattoo artist not to take pictures of you and your completed tattoo.
Informed Consent - COVID-19 Pandemic
I understand that I am opting for a service that is not urgent and not medically necessary.

I also understand that the coronavirus disease (COVID-19) has been declared a worldwide pandemic by the World Health Organization. I further understand COVID-19 is extremely contagious. State and federal health agencies recommend social distancing.

I recognize that the staff at Yarrow Studio are closely monitoring this situation and have put in place reasonable preventive measures targeted to reduce the spread of this virus. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 if I proceed with this elective service.

Accordingly I acknowledge and assume the risk of becoming infected with COVID-19 through this elective service and I give my express permission for the staff at Yarrow Studio to proceed with the same. This consent applies to any follow up or additional services in the upcoming months.

I understand that even if I have been tested for COVID-19 and received a negative test result, the tests may not have detected the virus or I may have contracted COVID-19 after the test. I will not hold this business and professional offering the service responsible for any liability related to COVID-19 and any variation or mutation thereof.

I understand that exposure to COVID-19 before, during, or after my procedure(s) may result in complications and/or delayed healing.

I have been given the option to defer my service to a later date. However, I understand all the risks including those noted herein and I would like to proceed with this service.

I understand the explanation and consent to the procedure.
By signing this form, I reaffirm the answers provided above.
Date*

MonthDayYear
Date
Type name:*
Client's Signature:

Clear
Please upload a photo of your ID.*
Artist's Signature:

Clear
Should be Empty:

Jillian Tattoo Consent Form

Informed Consent - COVID-19 Pandemic