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Tattoo Consent Form

What to Know Before Getting a Tattoo
While a tattoo may only take a few minutes to acquire, it is permanent. You should understand the risks and research the process before getting a tattoo. Tattooing involves breaking the skin, one of your body's main protective barriers. This means you may be more susceptible to skin and blood infections. Specific risks include:
Bloodborne diseases. If the equipment used to do your tattoo is contaminated with the blood of an infected person, you can contract a number of serious bloodborne diseases. These include hepatitis C, hepatitis B, tetanus and HIV, the virus that causes AIDS.

Skin infections. The use of unsterile equipment or re-used ink can result in skin infections, ranging from minor to potentially serious antibiotic resistant infections. Symptoms may include redness, swelling, or pus-like drainage.

Granulomas. Bumps may form around the site of the tattoo as a reaction to the ink.

Scars and keloids. The ink may cause scars and keloids (raised, ridged areas caused by overgrowth of scar tissue).

Allergic reactions. The ink may cause an itchy rash at the tattoo site.
Swelling or burning. Tattooed areas may swell or burn during Magnetic resonance imaging (MRI) exams.

Additional topics to discuss with your body art professional include their Bloodborne Pathogen Training, the establishment's proficiency requirements.

If abnormal itching, irritation, redness, swelling or fever should appear, please contact a physician immediately. These could be signs of a potentially serious medical condition that should be addressed.
To ensure that your body art procedure heals properly, we ask that you disclose if you have or have had any of the following conditions.

Disclosure does not legally prevent you from having a body art procedure.

Diabetes

History of hemophilia (bleeding)

History of skin diseases, skin lesions, or skin sensitivities to soaps, disinfectants, etc.

History of allergies or adverse reactions to pigments, dyes or other skin sensitivities such as latex

History of epilepsy, seizures, fainting or narcolepsy

Use of medications, such as anticoagulants that thin the blood and/or interfere with blood clotting

Human immunodeficiency virus (HIV)

Hepatitis

Please list any other information that might be relevant to your body art procedure:

Name

Phone Number

Email

Artist name

Date

Identity document (a driver's license is acceptable)

Signature

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The Illinois Department of Public Health

Division of Food, Drugs and Dairies

Springfield, Illinois • 217-785-2439

Printed by Authority of the State of Illinois

P.O. #5210321 2.5M 8/09