New Client Consultation Form

Hello!

We are messaging to confirm your tattoo appointment with Levi Lovett tomorrow. Please fill out and agree to the following to confirm.

Should you require a map to the shop or directional assistance please feel free to request from Brittany.

Name

First NameLast Name

GOV Issued Photo ID #: blanks*

I do require to see ID at appointment, please make sure to bring a valid form issued from the government for confirmation.

But providing said number I verify that I am of legal age to receive a tattoo (18 years old) and am aware that false information will result in permanent barring from Levi Lovett Ink.

Todays date

MonthDayYear

I prefer the following healing methods:

I have an allergy or allergies to the following. Select all that apply.

I, the client Agree to the following:

I am aware of the possible risks associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to, infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigments, aftercare bandage, and/or soap/skin cleansing products. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the desired body modification and I freely accept and expressly assume all and any risks that may arise from such procedure(s).

I acknowledge that it is possible that the tattoo can become infected, particularly if I don’t follow the instructions given to me. If any touch up work is needed due to my own negligence I agree that the work will be done at my own expense, I agree that it is my responsibility to obtain any and all information regarding the aftercare of my tattoo. Aftercare pamphlets will be provided at the end of appointment.

I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the artist without duress or coercion.

I do no have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I am not pregnant or have not recently given birth within the last 2 months. I have not undergone any major surgeries within the last 2 months. I do not have any other medical or skin conditions that may interfere with the application or healing of the tattoo. I am not a recipient of an organ or bone marrow transplant. It is my responsibility to consult a physician in advance of any invasive procedure such as tattooing in the event I deem it necessary. I confirm that I have been approved to proceed by my physician if any of the previously stated are a factor.

The artist is not responsible for the meaning or spelling of the symbol or text that I have provided them or chosen from flash (custom or design) sheets or images.

Variation in color or design may exist between the tattoo art I have selected and the actual tattoo when it it applied to my body, I also understand that overtime, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.

I understand that a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before the body modification procedure.

I release all rights to any photographs taken of me and the tattoos and give consent in advance to their reproduction in print or electronic form.

I agree to reimburse the artist for any and all attorney fees and costs incurred in ANY legal action (present or future) I bring against the artist in which the artist is the prevailing party. I agree that the courts of Alberta, Canada shall have litigation and dispute out of and/or related to this agreement.

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the artist.

I agree to pay the full amount owing for the tattoo session as quoted by the artist, even if I am unable to sit through the entirety of the scheduled appointment. If I am unable to make it through a full appointment, I agree that a new non-refundable deposit and appointment(s) will need to be made to continue the tattoo to completion. I am also aware that any and all money sent to the artist prior to or after appointment is non refundable.

I understand that I can be no more than 5 mins early for my appointment as there is limited seating space.

I understand that if I am not forthcoming about illness symptoms, I will be asked to leave and will not be rescheduled for future appointments.

I understand I am to not come to the shop with the following symptoms of Fever/chills, Cough, Sore throat, Congestion/runny nose, Nausea or Vomiting, extreme Diarrhea.

I understand that my tattoo will be automatically rescheduled if I do not fill out and comply to this form by end of business day, the day before my scheduled appointment.

I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible guest experience when visiting Levi Lovett Ink

Signature

Levi Lovett Ink Confirmation/Waiver