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Tattoo Consent Form
CLIENT INFORMATION
First Name
*
Last Name
*
Age
*
Date of Birth
*
Phone Number
*
Email
*
Address
*
PRE-PROCEDURE QUESTIONNAIRE
Location and description of Tattoo
*
Are you under the influence of any drugs or alcohol?
*
Are you under the influence of any drugs or alcohol?
Yes
No
FEMALE ONLY: Are you pregnant or breastfeeding?
FEMALE ONLY: Are you pregnant or breastfeeding?
Yes
No
Do you have any skin conditions?
*
Do you have any skin conditions?
Yes
No
Skin conditions (e.g. Rashes, Eczema, Infection, Psoriasis, Freckles, etc.) - If NONE, put "N/A"
Please tell about your medical history (e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.) - If NONE, put "N/A"
ACKNOWLEDGEMENT & WAIVER
Please check that you agree to the following:
*
Please check that you agree to the following:
I understand that this procedure is a permanent change to my skin and body.
I allow my tattoo to be photographed and be used for Tattoo Shop portfolio showcased.
I acknowledge that the Tattoo Shop does not offer refund.
I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.
I understand that I need to take care of the tattoo by following the instructions given to me by the Tattoo Shop verbally and in writing
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo.
I indemnify and hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities.
I confirm that the information I provided in this document is accurate and true.
Photo of your ID Signature
*
Click to choose a file or drag here
Size limit: 10 MB
Client Signature
*
Signature
Signature Date
*
Artist Signature
*
Signature
Signature Date
*
Submit
