Client Intake & Consent
INFORMED CONSENT & RELEASE
Iron Rose Tattoo Co LLC currently accepts clients ages 18 and older only. We are not accepting clients under the age of 18 at this time.
This Informed Consent & Release is required for all tattoo services provided by Iron Rose Tattoo Co LLC. By signing this document, you acknowledge that you have read and understand the information provided, have had the opportunity to ask questions, and voluntarily consent to receive tattoo services.
Iron Rose Tattoo Co LLC is an independently owned and operated tattoo business located within a private tattoo suite inside the premises of Black Diamond Barber Co. Iron Rose Tattoo Co LLC and Black Diamond Barber Co. are separate and independent businesses. Black Diamond Barber Co. does not provide, perform, supervise, or control the tattoo services provided by Iron Rose Tattoo Co LLC.
Tattoo Artist: Cody J. Hamiel - Iron Rose Tattoo LLC
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Tattoo Description
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Tattoo Location
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Emergency Contact Name & Number
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Are you currently pregnant or could you be pregnant?
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Have you consumed alcohol or recreational drugs within the past 24 hours?
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Please list any medical conditions, allergies, medications, blood thinners, supplements, or other health information that you believe may be relevant to receiving a tattoo. This may include, but is not limited to: allergies or sensitivities; blood-thinning medications or supplements; medications that may affect bleeding or healing; skin conditions; diabetes or other conditions that may affect healing; immune-system conditions or medications; history of fainting or seizures; pregnancy; recent illness; or any other health concern you believe Cody should be aware of before your appointment. If none apply, please enter “None.
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SEPARATE BUSINESS ACKNOWLEDGMENT I understand that Iron Rose Tattoo Co LLC and Black Diamond Barber Shop are separate and independent businesses. I understand that Iron Rose Tattoo Co LLC operates out of the premises of Black Diamond Barber Shop as a separate business entity. Black Diamond Barber Shop is not the tattoo artist, tattoo business, or provider of the tattoo services I am receiving from Iron Rose Tattoo Co LLC. I acknowledge that my tattoo services, tattoo consultation, tattoo procedure, payments, consent, aftercare, and any other services related to my tattoo are provided by Iron Rose Tattoo Co LLC, and not by Black Diamond Barber Shop. To the extent permitted by applicable law, I agree that Black Diamond Barber Shop is not responsible or liable for the tattoo services or tattoo-related services provided by Iron Rose Tattoo Co LLC, including the tattoo procedure, artistic results, healing, aftercare, or complications arising from the tattoo procedure. I understand that this acknowledgment does not waive or limit any rights or remedies that cannot legally be waived or limited under applicable law
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I agree
1. VOLUNTARY CONSENT I confirm that I am 18 years of age or older and am voluntarily requesting tattoo services from Iron Rose Tattoo Co LLC. I understand that tattooing is a permanent cosmetic procedure involving the intentional penetration of the skin and the placement of pigment beneath the skin. I have had the opportunity to discuss the tattoo design, placement, size, color, technique, procedure, expected healing process, risks, and aftercare with my tattoo artist. I have had the opportunity to ask questions, and my questions have been answered to my satisfaction. I understand that once the tattoo procedure begins, the tattoo cannot simply be removed or reversed. 2. RISKS AND POSSIBLE COMPLICATIONS I understand that tattooing carries inherent risks and that individual results and healing vary. Potential risks include, but are not limited to: Pain or discomfortBleeding or bruisingRedness, swelling, irritation, or tendernessInfectionAllergic or adverse reactions to tattoo pigments, inks, ointments, soaps, or other productsScarring or changes in skin textureChanges in pigmentationDelayed or abnormal healingFading, discoloration, blurring, or spreading of pigmentUneven pigment retentionChanges in the appearance of the tattoo caused by aging, sun exposure, skin type, or other factorsThe need for a touch-upUnsatisfactory or unexpected artistic resultsDifficulty or inability to completely remove the tattoo I understand that complications can occur even when appropriate professional sanitation and tattooing practices are followed. 3. HEALING AND AFTERCARE I understand that proper aftercare is my responsibility once I leave the studio. I agree to follow the written and verbal aftercare instructions provided by Iron Rose Tattoo Co LLC. I understand that failure to properly care for my tattoo may increase the risk of infection, poor healing, scarring, pigment loss, or an unsatisfactory final result. I understand that Iron Rose Tattoo Co LLC cannot control my activities, hygiene, environment, exposure to sunlight, water, chemicals, friction, or other factors after I leave the studio. I agree to seek appropriate medical attention if I develop symptoms that concern me or appear to indicate a possible infection or other medical complication. 4. CLIENT HEALTH DISCLOSURE I certify that I have truthfully disclosed any information reasonably relevant to my ability to safely receive a tattoo. I understand that I should inform my artist before the procedure if I have: Known allergies or sensitivitiesA history of reactions to tattoo ink or pigmentsA skin condition affecting the tattoo areaAn active rash, wound, infection, or other abnormality in the tattoo areaA condition or medication that may affect bleeding or healingAny other concern that I believe may affect the tattoo procedure or healing process I understand that Iron Rose Tattoo Co LLC may refuse, postpone, or modify a tattoo procedure if the artist reasonably believes doing so is necessary for safety, sanitation, or other legitimate professional reasons. 5. ARTWORK, DESIGN & PLACEMENT I understand that I am responsible for approving my tattoo design and placement before the procedure begins. I understand that tattooing is performed on human skin and that the final result may vary from a digital image, drawing, stencil, reference photograph, or other representation. I acknowledge that differences
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I agree
Signature
ELECTRONIC SIGNATURE & ACKNOWLEDGMENTBy submitting this form, I confirm that I have read and understand the entire Iron Rose Tattoo Co LLC Informed Consent & Release. I have had the opportunity to ask questions, and I voluntarily consent to receive tattoo services from Iron Rose Tattoo Co LLC.I certify that I am 18 years of age or older and that the information I have provided is true and accurate.Type Your Full Legal Name Below
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ELECTRONIC SIGNATURE & ACKNOWLEDGMENT Tattoo Artist: Cody J. Hamiel
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I agree
I understand that typing my full legal name below and submitting this form constitutes my electronic signature and acknowledgment of this Informed Consent & Release.
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I agree
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