Tattoo Consent Form
Please complete this consent form before your tattoo appointment. It collects identity, medical safety, appointment details, and required legal acknowledgments. You will also be asked to submit a copy of a government issued photo ID.
Client Identity & Contact
Full Legal Name
*
First Name
Middle Name
Last Name
Preferred Name (if different from above)
First Name
Last Name
Preferred Pronouns
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Government ID Type
*
Please Select
Driver's License
State ID
Passport
Other
Government ID Number
*
Add Government ID Photo
*
Emergency & Medical Information
Emergency Contact Name
*
First Name
Middle Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Conditions
Diabetes
Epilepsy/Seizure Disorder
Hemophilia or Bleeding Disorder
Heart Condition
Skin Condition
Other
Any allergies or current medications?
Tattoo Appointment Details
Area to be tattooed
*
Design description
*
Artist name
*
Date of appointment
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Consent, Waivers & Acknowledgments
Photo and Video Consent
*
I consent to photos and videos being taken and used for studio records, portfolio, and promotional purposes
I do not consent to photos and videos being taken or used
Aftercare Instructions Acknowledgment
*
I have read and understand the aftercare instructions. *Please ask your artist if you have any questions or concerns regarding the aftercare instructions - these will be provided to you in verbal and written form by your artist.
Pregnancy and breastfeeding Acknowledgment
*
I confirm that I am neither pregnant nor breastfeeding at the time of the tattoo appointment.
Health Risk Disclosure Acknowledgment
*
I am aware that tattooing involves health risks and possible complications and I accept full liability for any possible risks and complications that arise from the tattoo procedure.
Liability Waiver Acknowledgment
*
I acknowledge and agree to hold Arcana (Selcouth LLC) harmless from any liability claims and agree to pay the resulting legal fees should I bring prosecution against the company for any reason.
Age Confirmation
*
I confirm that I am at least 18 years old
Terms Confirmation
*
I have read and understood all terms and conditions
How did you hear about us?
*
Please Select
friend/word of mouth
Instagram
Google Search
Reddit Search
Walking by
Other
Client Signature
*
Signature Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: