• Tattoo Consent Form

  • Client Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Pre-Appointment Information

  • Date of Appointment*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Have you been tattooed before?*
  • Are you under the influence of drugs or alcohol?*
  • Are you pregnant or breastfeeding?*
  • Do you have any allergies to latex or adhesives?*
  • Are you currently taking any medications that may effect healing/bleeding?*
  • Do you have a heart condition?*
  • Are you a hemophiliac?*
  • Do you get keloids?*
  • Do you have a history of epilepsy?*
  • Do you have a history of epilepsy?*
  • Do you have a tendency of fainting/lightheadedness?*
  • May I photograph/record this process &/or your tattoo for marketing and portfolio purposes?*

  • Consent + Acknowledgement

  • Tattoo Procedure Consent

    I acknowledge that I am voluntarily receiving a tattoo and have been given the opportunity to ask questions regarding the procedure.

    I understand that:

    • This procedure is a permanent change to my skin and body.
    • Tattooing involves piercing the skin and carries risks including infection, allergic reactions, scarring, and dissatisfaction with the final result.
    • It is not reasonably possible for the Representatives/Tattoo Artist to determine whether I might have an allergic reaction to the pigments or products used during the tattoo process and I agree to accept the risk that such a reaction is possible.
    • Tattoo colors may fade or change over time.
    • Variations in skin type and healing may affect the appearance of the tattoo.
    • Touch-ups may be necessary and may incur additional charges.
    • No guarantees have been made regarding the outcome of the tattoo.

    I acknowledge that:

    • I have received, reviewed, and understand the aftercare provided to me.
    • If any type of infection or rash appear or the tattooed area after the procedure, I will advise my tattoo artist.
    • Proper healing is also dependent on following these instructions and that failure to do so may affect the appearance of my tattoo.
    • The artist and studio are not responsible for complications, infections, excessive fading, or poor healing resulting from my failure to follow the provided aftercare instructions.

    Release of Liability

    I release the tattoo artist, Ashleigh Antrim, and the studio from liability related to the tattoo procedure except in cases of gross negligence or misconduct.

    I release any and all persons representing 72 Hours LLC / Ashleigh Antrim from all responsibility. I accept any and all responsibility myself for the consequences that might stem from my decision to have any tattoo done by the artist. I agree to not sue 72 Hours LLC / Ashleigh Antrim for damages from my decision to have any tattoo work. I agree for myself, heirs and legal representatives to hold 72 Hours LLC / Ashleigh Antrim harmless of all damages, actions, causes of action, claim judgements, costs of litigation, attorney's fees and all other expenses which might arise from my decision to have any tattoo related work done by 72 Hours LLC / Ashleigh Antrim.

    I hereby acknowledge that by signing this agreement, I certify that all information provided is true.

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