Clone of Consent Form | Still.

Clone of Consent Form | Still.

First name
Last name
Phone
Email
example@example.com
Birthday

DayMonthYear
Date

Please include a short description of the tattoo(s) you’re having done today including rough size and placement.

Please select Yes/No for the following statements. If you select “Yes” for any of the statements please make your tattoo artist aware.

I have previously had an allergic reaction to a tattoo.

I am prone to fainting.

I suffer from a heart condition.

I am prone to keloid scars.

I have an allergy e.g latex, plasters.

I suffer from any know blood born virus e.g. HIV, Hep B.

I suffer from a skin condition e.g. eczema, psoriasis.

I am regularly taking prescribed medication.

I suffer from Haemophilia/ other blood clotting disorder.

I am pregnant.

I suffer from diabetes or lupus.

I suffer from epilepsy.

If you feel there is anything your artist should be aware of please make them aware now.

I declare that I give my full consent to the tattoo(s) being carried out by the artist(s). I understand the potential complications e.g. infection and swelling. I confirm that the aftercare instructions have been explained to me and that following them is my responsibility.

I understand that the tattoo procedure involves permanent insertion of ink pigments into the dermis layer of my skin using sterilised equipment.

I agree that I have checked the spelling, design and placement of the tattoo and am happy to go ahead.

I consent to filming and photography.

I confirm that the information I have provided above is correct, that I am over the age of 18 and not currently under the influence of drugs or alcohol.
Should be Empty: