Tattoos By Charlene – 2026 Tattoo & Piercing Consent, Medical History & Aftercare Form

Tattoos By Charlene – 2026 Tattoo & Piercing Consent, Medical History & Aftercare Form

Please complete this form carefully before your appointment. It is designed to support informed consent, medical disclosure, aftercare acknowledgement, and studio policies.
Client Details & Age Verification

Please confirm the client’s age and complete the relevant details below.
Full Legal Name

First NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you 18 years old or older?
Parent / Legal Guardian Full Name

First NameMiddle NameLast Name
Client Phone / WhatsApp Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Appointment Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Studio / Location
Parent / Legal Guardian Full Name

First NameMiddle NameLast Name
Relationship to Client
Please state how you are related to the client.
Parent / Legal Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Service Details

Please provide the details needed to prepare for the appointment.
Service Type
Service Details
Please include design, area of the body, size, placement, and any notes relevant to the procedure.
Placement and Notes
Use this space for placement preferences, sensitivities, or other helpful details.
Medical History & Pre-Service Screening

Please answer honestly. Your responses help us assess suitability and safety.
Do you have any allergies or sensitivities?
If yes, please describe your allergies and reactions
Do you have any skin conditions or active skin concerns?
If yes, please describe your skin condition or concern
Have you ever been diagnosed with a blood-borne infection?
Do you have diabetes?
Do you have any immune system condition or take immune-suppressing medication?
Do you have any heart condition or circulation concern?
Have you experienced any of the following?
Are you pregnant or breastfeeding?
Have you used any of the following recently?
Do you tend to keloid or scar heavily?
Do you have a history of slow healing or healing complications?
Have you eaten and had enough water today?
Consent, Risks, Policies & Aftercare
I confirm that the information I have provided is accurate and complete
I understand tattooing and piercing may involve pain, bleeding, infection, allergic reaction, scarring or keloid formation, pigment changes, migration or rejection where relevant, and healing may vary from person to person
I understand placement-specific retention or fading may be less predictable on fingers, hands, feet, and other high-friction areas
I understand healing can be affected by washing, friction, sun exposure, swimming, sweating, work, sports, and general daily activity
I understand touch-ups may be chargeable after the initial healing period and are assessed once the area is fully healed
I understand and agree to the studio’s booking, deposit, cancellation, and other service policies
I give permission for treatment only after consultation, and understand the artist or piercer may refuse or postpone service if it is unsafe or if I am unwell or intoxicated
I understand this consent form does not replace professional medical advice, and I will follow the aftercare instructions provided for my tattoo or piercing
Final Declaration & Signature
Final declaration
Typed signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Consent and acknowledgement
Should be Empty:

Tattoos By Charlene – 2026 Tattoo & Piercing Consent, Medical History & Aftercare Form

Client Details & Age Verification

Service Details

Medical History & Pre-Service Screening

Consent, Risks, Policies & Aftercare

Final Declaration & Signature