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@GODXEAR | B.LIEW Tattoo Procedure Form

FIRSTLY READ THE CLIENT INFO | GUIDELINES PAGE ON MY WEBSITE BEFORE PROCEEDING

CLIENT INFORMATION

Name

Last

Date of Birth

Age

Phone Number

Email

ADDRES

CITY

STATE

ZIP

Pre-Procedure Health Questionnaire

Are you under the influence of drugs or alcohol?

FEMALE ONLY: Are you pregnant or nursing?

Do you have a communicable disease?

Do you have any skin conditions?

Do you take blood thinners, antibiotics, or immunosuppressants?

Please list any skin conditions (e.g., eczema, rashes, psoriasis, etc.)

Please share relevant medical history (e.g., diabetes, epilepsy, cardiovascular conditions, etc.)

Do you have any allergies (including to pigments, gloves, ointments, or soaps)?

Proof of Age & Identity : Upload ID

Size limit: 10 MB

Please upload a clear image of your (e.g., passport, driver’s license). This confirms you are at least 18 years old.

This is required before proceeding and will be stored securely.

Acknowledgement & Waiver

I have read the client info | guidelines | policies on the godxear website

I understand this procedure is a permanent change to my body.

I am not under the influence of drugs or alcohol.

I am not pregnant or nursing.

I acknowledge tattooing may carry risks including infection, allergic reaction, or scarring.

I understand tattoos on hands, feet, or joints are more prone to fading or blurring.

I release the artist (Brandon Liew) and GODXEAR Studio from all liability.

I understand tattoos may fade or shift with time, sun exposure, and skin changes.

I have received and understand tattoo aftercare instructions.

I understand touch-ups may incur additional cost unless agreed beforehand.

I allow my tattoo to be photographed and used for portfolio or promotional purposes.

I understand that no refunds are given for tattoos.

I confirm all the information I have provided is accurate and true.

Signature

Signed Date

Thank you for your trust. If you have any questions before or after the tattoo session, feel free to ask — I’m happy to walk you through any concerns. This form is to make sure we’re both protected and on the same page.