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Tattoo Location
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Name of Artist
If you're unsure, please ask
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Tattoo Placement on body
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Client Name
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Date of Birth
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Address
Address Line 1
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Address Line 2
City
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Postal Code
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Phone Number
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Email Address
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Have you consumed drugs or alcohol in the last 24 hours?
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Yes
No
Have you eaten in the last 4 hours?
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Yes
No
Medical Information
It is important you answer these questions truthfully
Do you have skin complaints (Eczema, Psoriasis, etc)
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Yes
No
Do you suffer from any allergies?
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Yes
No
Are you prone to fainting attacks / dizziness
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Yes
No
Do you take regular medication?
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Yes
No
Do you take blood thinning medication or do you suffer from haemophilia?
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Yes
No
Could you be pregnant or are you breastfeeding?
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Yes
No
Do you have any heart complaints or conditions?
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Yes
No
Do you have any immune conditions such as HIV, AIDS, or Hepatitis?
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Yes
No
Do you have epilepsy, diabetes, or asthma?
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Yes
No
Any other associated health conditions that could be contraindicated by the treatment?
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Yes
No
If you answered "Yes" any of the Medical questions, please provide more info
Emergency contact
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Hazards
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I am aware of the potential hazards that may be associated with my tattoo and have considered these before giving consent to the procedure(s). I agree to the procedure(s) fully understanding the risks. These include damage to skin tissue and nerves, scar tissue formation, localised swelling, pain and/or discomfort. It can also include allergic reactions, skin infections (such as staph infections), tuberculosis, blood poisoning/septicaemia, and blood-borne diseases (such as hepatitis B, hepatitis C and HIV).
Aftercare
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I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. I take full responsibility for the healing of my tattoo on exit of studio and agree to follow aftercare given to me by my artist after my procedure.
Release
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I agree to waive and release, to the fullest extent permitted by law, the artist and the studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise, whether caused by the negligence or fault of either the artist or the studio, or otherwise.
Duress
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I confirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a tattoo without duress.
Design
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I consent to the design that is going to be tattooed. Neither the artist or the studio is responsible for the meaning any symbols or spelling of text. I have double checked any numbers or spelling and confirm that it is correct. I am happy with the design and the placement on my body. I acknowledge variations in colour/design may exist between the art I have selected and the actual tattoo. I also understand that over time, the colours and the clarity of my tattoo will fade due to natural dispersion of pigment under the skin.
Permanent Change
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I acknowledge a tattoo will result in a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and costly and which in all likelihood will not result in the restoration of my skin.
About this form
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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.
Please read carefully
I declare that the above information is true and correct to the best of my knowledge. I am over 18 years old and able to give full consent for the procedure detailed above. I am not under the influence of drugs or alcohol.
I hereby give consent for the artist named above to carry out the tattoo procedure and have approved the design to be used. I understand the potential risks and complications that are associated with the procedure and confirm that I have been given access to the appropriate aftercare advice. I understand that it is my responsibility to carry out the instructions as suggested by the operator to assist the best possible healing conditions for my tattoo.
I consent to photographic images to be taken of my tattoo and used for advertising or portfolio purposes on social media/print media by both the studio and the artist. This may extend to third parties given approval by the studio or the artist
I understand that the studio has CCTV used solely for the protection of the artists, staff, and clients. Footage will be stored on a secure server for a period of 30 days and will be provided to the police if an incident occurs.
I give consent for the information on this form to be held by the operator and studio for a minimum of two years from the date of the procedure.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Confirmation
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I have read this form carefully and confirm that all of the information is correct to the best of my knowledge
Marketing
Occasionally we would like to send out emails to notify people about promotions, guest artists and cancellations. If you want in, let us know.
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Yes please, email me with awesome offers
No thanks
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