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CONSENT FORM

Please do not fill out this form unless it is your session day 😊🙏

Name on legal ID

*

Preferred name

Pronouns

Date of birth

*

E-mail

*

Phone Number

*

Emergency contact name and phone number

*

Street| City | Post code

Do you have any of the following conditions?

*

Do you have any of the following conditions?

HIV

Hepatitis A, B, C or D

Epilepsy

Fainting & dizziness

Chronic skin disease

Diabetes

Heart conditions

Any blood clotting disorders

None of the above

Do you have any other relevant health conditions?

*

Do you have any known allergies?

*

Are you preganant or breastfeeding?

*

Are you preganant or breastfeeding?

Yes

No

Do you take any medications?

*

Do you take any medications?

Yes

No

Have you consumed any alcohol or drugs today?

*

Have you consumed any alcohol or drugs today?

Yes

No

- Do you acknowledge and agree that getting a tattoo will result in a permanent change to your body?

- Do you understand that you might have an allergic reaction to certain pigments or ingredients in the tattoo ink, and Skakerya/Sasha cannot detect this before your appointment?

- Do you understand that improper aftercare of your tattoo could lead to infection or injury, and Skakerya/Sasha or the studio is not liable for this, nor can we offer refunds?

*

- Do you understand that improper aftercare of your tattoo could lead to infection or injury, and Skakerya/Sasha or the studio is not liable for this, nor can we offer refunds?

Yes

- Do you understand that consent is continuous, and if at any time you feel unwell, uncomfortable, wish to stop the procedure, or need a break, you are strongly encouraged to let us know?

*

- Do you understand that consent is continuous, and if at any time you feel unwell, uncomfortable, wish to stop the procedure, or need a break, you are strongly encouraged to let us know?

Yes