F Segismundo Tattoo Consent Form

F Segismundo Tattoo Consent Form

@fksegismundo
Today’s Date*

MonthDayYear
Date
Legal Name*

First NameLast Name
Your Date of Birth*

MonthDayYear
Date
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Email*
example@example.com
State License / ID Number*
Your Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
I acknowledge that I am receiving my tattoo in the following placement:*

ArmLegRibBackOther
Acknowledgement

I acknowledge by signing this consent form that I have been given the full opportunity to ask any questions that I might have about obtaining a tattoo and that all of my questions have been answered to my full satisfaction. The tattoo artist will use new needles for the tattoo and provide the appropriate care instructions once the tattoo is complete. I hereby release my tattoo artist, Frances Segismundo, from all liability, claims, actions and demands in law, or in equity, which I may have by obtaining this tattoo.

I also acknowledge I have truthfully and accurately answered all questions below:
Are you over 18 years old?*

YesNo
Are you prone to fainting?*

YesNo
Do you have diabetes?*

YesNo
Do you have difficulty-stopping bleeding?*

YesNo
Do you take blood thinner?*

YesNo
Do you have heart-related issues?*

YesNo
Do you have epilepsy?*

YesNo
Do you have high blood pressure?*

YesNo
Do you have any known allergies?*

YesNoIf yes, please list
Have you consumed any anticoagulants (aspirin, ibuprofen, etc.) in the past 8 hours?*

YesNoIf yes, please list
Have you consumed any food within the last 3 hours*

YesNo
Are you under the influence of drugs or alcohol?*

YesNo
Do you have any conditions that may affect the healing of this tattoo?*

YesNoIf yes, please list
Are you pregnant or nursing?*

YesNo
Do you have any medical or skin conditions, like acne, scarring, psoriasis, or sunburn that may interfere with your tattoo?*

YesNoIf yes, please list
Do you acknowledge that it is not reasonably possible for your tattooed to determine whether you might have an allergic reaction to your tattoo/ink and cape that risk of allergic reaction is possible?*

YesNo
Do you acknowledge that blow outs and infections are always possible as a result of being tattooed, during the tattoo or if you do not take proper care of the tattoo?*

YesNo
Do you acknowledge that any touch up work needed will be done at your own expense, unless stated otherwise by the tattoo artist?*

YesNo
Do you acknowledge that variations in colour and design between the tattoo as selected and as ultimately applied to your body may occur?*

YesNo
Do you acknowledge that any skin treatments, laser hair removal, plastic surgery, or other skin altering procedures may adversely affect your tattoo?*

YesNo
Do you acknowledge that a tattoo is a permanent change to your appearance and that no promises have been made to you about the ability to later change or remove the tattoo?*

YesNo
Do you agree to pay your artist’s hourly rate or set amount, as determined by the artist upon completion of the tattoo?*

YesNo
Do you release all rights to any photographs taken of you by your tattoo artist and give consent in advance to their reproduction in print or electronic form?*

YesNo
Do you consent to being filmed during the tattoo session, for the purposes of social media and marketing?*

YesNo
If no, please remind your tattoo artist not to take pictures of your and your completed tattoo.
By signing this form, I reaffirm the answered provided above
Date*

MonthDayYear
Date
Type Your Full Name*
Client Signature*
Please pass your phone to the artist to sign and check your ID
Photo of ID card*

Cancelof
Tattoo Artist Signature*
Thank you for your business!
Should be Empty: