Tattoo Consent Form

Tattoo Consent Form

THE ART SANCTUARY STUDIO
Client Information
Name

First NameLast Name
Birth Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Phone Number
Format: (000) 000-0000.
ID Type
State
ID Number
Email
example@example.com
Artist
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
FEMALE ONLY: Are you pregnant or nursing?
Do you have a communicable disease, blood disease, or HIV?
Do you have any skin conditions?
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease, blood thinning medication ( please speak to your artist in person if taking any blood thinning medication etc.)
If yes, please identify the condition.
Acknowledgment and Waiver
Client Signature
Date signed

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty: