Tattoo Consent and Liability Form
Please provide your health information and allergies to ensure a safe tattooing process.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
EMERGENCY CONTACT
*
First Name
Last Name
EMERGENCY CONTACT #
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any allergies? (e.g., latex, ink, adhesives, medications)
*
No
Yes
If yes, please specify your allergies
Do you have any medical conditions? (e.g., diabetes, heart condition, skin disorders)
*
No
Yes
If yes, please specify your medical conditions
Are you currently taking any medications?
*
No
Yes
If yes, please list your medications
Tattoo Placement (area of the body)
*
TERMS AND CONDITIONS
Please read TERMS AND CONDITIONS and check each box.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
Should be Empty: