Tattoo Consent & Release Form
Client Information
Full Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
Age:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
ID Type/Number/State:
Health & Medical Questionnaire
(Please check Yes or No)
Under the influence of drugs or alcohol.
Yes
No
Pregnant or breastfeeding.
Yes
No
I have eaten in the last 4 hours.
Yes
No
Epilepsy, seizures, or fainting spells.
Yes
No
Diabetes, heart conditions, or high/low blood pressure.
Yes
No
Taking blood-thinning medication (aspirin, anticoagulants).
Yes
No
Bleeding disorder (hemophilia, clotting problems).
Yes
No
Skin conditions (eczema, psoriasis, rashes, infections).
Yes
No
Any immune system conditions or slow healing.
Yes
No
Scar easily or develop keloids.
Yes
No
Any allergies to: metals, latex, adhesives, pigments, lidocaine, numbing agents, or soaps.
Yes
No
Any cold/flu symptoms, infections, or open wounds.
Yes
No
Back
Next
Surgery or hospitalization in the past 6 months.
Yes
No
Acknowledgements (Please Initial Each)
I understand that tattooing involves breaking the skin and carries risks of infection, allergic reaction, scarring, and transmission of bloodborne pathogens (HIV, Hepatitis B, Hepatitis C).
I acknowledge that tattoo inks are not FDA approved and may cause allergic reactions.
I understand tattoos may fade, blur, or change appearance over time, and colors may heal differently.
I accept responsibility for the spelling, grammar, and design choices of my tattoo.
I understand that proper after care is my responsibility.
I understand that touch-ups may be needed and may be at my own expense.
I release ReINKarnated Body Arts, its artists, and employees from liability for any complications.
Signatures
Client Signature:
Date:
-
Month
-
Day
Year
Date
Artist Signature:
Date:
-
Month
-
Day
Year
Date
Preview PDF
Submit
Should be Empty: