Tattoo Services Consent Form (Massachusetts)
Please complete this form to provide consent for tattoo services and upload a valid photo ID as required by Massachusetts law.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Upload a valid photo ID (required for age verification)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Are you pregnant or breastfeeding?
Yes
No
Are you under the influence of drugs or alcohol?
Yes
No
Do you have any of the following?
Blood-borne diseases
Immunodeficiency/autoimmune disorders
Bleeding or clotting disorders/Hemophilia
History of scarring/keloid scarring
Allergies (latex, inks, pigments)
Other
*If answered YES above, please explain:
Signature (required)
*
Submit Consent
Submit Consent
Should be Empty: