Tattoo Waiver, Release, and Consent Form

Tattoo Waiver, Release, and Consent Form

Please review and complete the form to give your consent for the tattoo procedure.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any allergies, medical conditions, or are you currently taking any medications?*
Have you eaten in the last 4 hours?*

YesNo
Tattoo Placement (Body Location)*
Tattoo Description*
Signature (Please sign below to confirm your consent and agreement to the terms above.)*
Date Signed*

MonthDayYear
Date
Should be Empty: