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South Shore Tattoo Co.
Let us do this part
Today's Date:
Mon Nov 18 2024 11:32
Practitioner:*
Consent for Body Art Procedures
Please read and answer
Medical History/Conditions*
I have disclosed any information about a medical condition I have that may affect the healing of my tattoo, such as: eczema, psoriasis, rashes, acne, scarring (keloid,) freckles, moles or sunburn in the area to be tattooed/pierced. I acknowledge that without proper aftercare, infection is always possible and I will follow all aftercare instructions I was given by my Body Artist. I acknowledge that it is not reasonable for the Artist to determine whether I may or may not have an allergic reaction to the pigments or products used during the process of my tattoo/piercing, and I will disclose any known allergies to products that may be used.
Adverse Affects*
I acknowledge that Body Art procedures are invasive and may involve possible health risks, especially for those with underlying medical conditions. I am also aware that I should consult with my physician prior to receiving any Body Art Procedure. If I experience an adverse affect during the healing period related to the Body Art Procedure, I have been advised to seek medical care as soon as possible and advise the Body Artist and/or Body Art Establishment where I received the procedure as soon as possible.This facility holds no liability in the event that my tattoo does not heal as expected, due to any unforeseen issues with the quality of my skin, medical conditions or improper aftercare.
Health Risks*
I acknowledge that it is possible to become infected with Hepatitis B, Hepatitis C, HIV or any other blood-borne disease with any procedure that involves exposure to blood products or instruments contaminated with blood products. In addition, I understand that an individual cannot donate blood for 12 months after having any body art procedure.
Aftercare *
I have been provided with a copy of aftercare instructions, as well as given verbal instructions by my Body Artist on how to properly heal my Tattoo/Piercing.
Consent to Design*
I acknowledge that the artist will show me my design on paper upon my arrival and stencil it onto me before we begin the tattoo procedure. It is my responsibility to point out any incorrect spellings of names, wrong dates, information that is specific to me, etc. before we begin so that if needed the design can be altered.
Informed Consent*
I have read and I understand the provided information and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am free to withdraw at any time, without giving a reason. I understand that I will be given a copy of this consent form via email.
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.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.
Legal Name:*
Chosen name:
Address:
Postcode:
Date of birth:*
You must be 18 or older
Phone #:*
Email:*
Signature:*


Photo ID*
Please take photo(s) of your government issued photo IDs and related paperwork.