Doomsday tattoo

Client release form

Complete this adult client consent form for your Texas tattoo visit, including health questions, acknowledgments, and e-signature. By completing this form you agree to being contacted via text or email for internal shop information, and or promotions. Keeping in mind audio and or video recording may take place in the shop while you are present.
Client Information
Take a clear photo of the front of your government-issued photo ID. Your name, address and date of birth will be entered automatically. Review the information for accuracy before continuing.
Full Legal Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Street Address
City
State
ZIP Code
Email Address
example@example.com
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Identification
Type of Photo ID Presented

Other
ID Issuing State or Country
ID Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Last 4 Characters of ID Number
Acknowledgment of Valid ID
Tattoo Service Information
Tattoo Artist
Appointment Type
Tattoo Location on Body
Tattoo Description
Ink Style
How did you find us?
First Visit to Doomsday Tattoo
Tattoo Risks and Consent
I understand the risks of tattooing, including pain or discomfort, permanence, infection, allergic reaction to inks, pigments, or aftercare products, scarring or skin irritation, and possible variation in the healed result.
Aftercare
I. for at least two weeks, minimize exposure to the sun, and discourage swimming in fresh, salt, or chlorinated water; II. properly cleanse the tattooed area; III. apply antibiotic ointment or cream; IV. use sterile bandage(s) or other sterile dressing(s) when necessary; V. the client shall consult a health care practitioner at the first sign of infection or an allergic reaction, and report any diagnosed infection, allergic reaction, or adverse reaction resulting from the tattoo to the artist and to the Texas Department of State Health Services, Tattoo and Body Piercing Program at (512) 834-6711.
Signature
Typed Full Legal Name

First NameMiddle NameLast Name
Electronic Signature
Date and Time Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Should be Empty:

Client release form

Client Information

Identification

Tattoo Service Information

Tattoo Risks and Consent

Aftercare

Signature