Intake Form
CLIENT DETAILS
Full Name
*
First Name
Last Name
Pronouns
Date of Birth
*
-
Day
-
Month
Year
dd-mm-yyyy
Email Address
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Instagram @
*
Postcode
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone
*
-
Area Code
Phone Number
I confirm I am 18 years or older
*
Yes
No
Photo of ID
*
Browse Files
Drag and drop files here
Choose a file
Government-issued photo ID (such as an Passport, Drivers License or Photo Card)
Cancel
of
HEALTH DISCLOSURE
Please tick any of the following that apply to you. Leave blank if not relevant.
*
I am currently pregnant or breastfeeding
I have diabetes
I have a blood disorder (e.g. haemophilia, clotting issues, anaemia)
I have a skin condition in or near the tattoo area (e.g. eczema, psoriasis, keloid scarring, moles)
I have allergies (especially latex, nickel, ink pigments, topical anaesthetics, antibiotics)
I am currently taking medications (e.g. blood thinners, Accutane/isotretinoin, immunosuppressants, steroids)
I have had surgery or a medical procedure in the last 6 months
I have a heart condition, epilepsy, or a history of fainting
I have an infectious condition I need to disclose (e.g. HIV, hepatitis)
I have consumed alcohol or drugs in the 24 hours before my appointment
Other
Do you have any accessibility or accommodation requirements to help you during the tattoo design and application process?
*
If you ticked any of the above, please provide details: Is there anything else about your health I should know?
I confirm the above information is accurate and complete to the best of my knowledge. I understand that failing to disclose relevant health information may result in my appointment being refused or postponed, and may result in forfeiture of my deposit.
*
Yes
SKIN & LIFESTYLE
Have you had sunburn or significant sun exposure on the tattoo area in the last 2 weeks?
*
Yes
No
Do you plan to swim, sauna, or sunbathe in the 2 weeks following your appointment?
*
Yes
No
Will you be flying within 48 hours of your appointment?
*
Yes
No
Are you generally well-hydrated and able to eat a proper meal before your session?
*
Yes
No
CONSENT & ACKNOWLEDGEMENTS
Please tick each item to confirm. All are required.
*
I have read and agree to the 6thouse Booking, Deposit & Studio Policy
I understand my deposit is non-refundable and contributes toward the final cost of my tattoo
I understand that quotes are estimates and final cost may vary based on time taken on the day
I understand that tattooing carries inherent risks including (but not limited to) infection, allergic reaction, scarring, and variation in healing outcomes
I understand that tattoos are permanent and that healed results may differ from the fresh appearance
I confirm I am not under duress, intoxicated, or being coerced into getting this tattoo
PHOTOGRAPHY & MARKETING
I consent to 6thouse photographing my tattoo for portfolio and social media use.
*
Yes
No
I am happy to be tagged on Instagram
*
Yes
No
I would like to receive occasional emails about 6thouse availability and flash drops.
*
Yes
No
PRIVACY ACKNOWLEDGEMENT
I understand that my personal information will be stored securely and used only for the purposes of my booking, aftercare, and (where I have consented) marketing communications, in accordance with the 6thouse privacy practices.
*
Yes
FINAL ACKNOWLEDGEMENT
By submitting this form, I confirm that all information provided is true and accurate, and that I have read and agreed to the 6thouse Booking, Deposit & Studio Policy.
*
Yes
Client Signature
*
Date
*
-
Day
-
Month
Year
Today's Date
Submit
Submit
Should be Empty: