Tattoo

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Let us do this part

Today's Date:

Wed Apr 2 2025 12:19

Practitioner:*

Tattoo Placement :*

Tattoo Price:

Please read and answer

How did you hear about us?

Do you have Flu like symptoms?*

For example:
- Fever
- Flu-like symptoms
- Shortness of breath
- Cough

Do you currently have any bloodborne pathogens, transmittable diseases, or recent illnesses?*

It's perfectly fine if you do; we simply want to ensure the safety of both our staff and other clients.

During the tattoo process, various bloodborne pathogens can potentially be transmitted. Some of the common ones include:

- Hepatitis B Virus (HBV)
- Hepatitis C Virus (HCV)
- Human Immunodeficiency Virus (HIV)
- Staphylococcus aureus (Staph)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Syphilis
- Herpes Simplex Virus (HSV)
-Human T-lymphotropic virus (HTLV)

Tattoo artists and clients must take necessary precautions to prevent the transmission of these pathogens during the tattooing process.

Do you have any of the following health conditions?*

By checking no I am confirming I do not have diabetes, epilepsy, hemophilia, or a heart condition, or taking blood thinning medication. Or any other condition that may interfere with the application or healing of the tattoo. Or the recipient of an organ or bone marrow transplant. That I am not pregnant or nursing. Or have a mental impairment that may affect my judgment in getting the tattoo.

Are you presently under the influence of drugs or alcohol? *

By checking no I am confirming I am not under the influence of alcohol or drugs, and I am willingly consenting to be tattooed by the Artist without any form of pressure or coercion. I understand that being under the influence during the procedure may negatively impact healing and may result in errors during the tattooing process due to my own physical impairment. Consequently, I absolve the studio and artist of any responsibility or liability associated with these circumstances.

Have you eaten?*

Eating beforehand is advisable to maintain adequate blood sugar levels. There are risks associated with undergoing a tattoo procedure on an empty stomach like fainting and you acknowledge that the studio is not liable for any consequences resulting from not eating beforehand.

If you have not eaten within the last four hours let the studio know so a solution may be provided.

Risks*

I am fully informed of the inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risks, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks.

Waive*

I WAIVE AND RELEASE to the fullest extent permitted by law each of 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 from my tattoo, whether caused by the negligence or fault of either the Artist or the Tattoo Studio or otherwise.

Aftercare & Healing*

I acknowledge that I will receive instructions regarding the proper care of my tattoo during the healing process once the procedure is completed. I anticipate receiving the instructions via email upon completion of this form, and I acknowledge that they are also accessible on the studio's website. Additionally, I recognize that the QR code provided, which links to this consent form, also includes a direct link to the aftercare instructions.

I confirm that I understand these instructions and am committed to following them diligently.

I am aware of the possibility of infection if the aftercare instructions are not adhered to properly. In the event that touch-up work on the tattoo is required due to my negligence, I agree to cover the associated expenses.

Spelling*

I acknowledge the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets.

Fading*

I know variations in color/design may exist between the art I have selected and the actual tattoo. I also understand that over time, the colors and the clarity of my tattoo will fade due to the natural dispersion of pigment under the skin.

Permanent*

I am aware that a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin.

Legal Action*

I agree to reimburse each of the Artist and the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of New Jersey in the United States of America shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.

Questions*

I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.

Photography*

I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (Please advise your Artist if you decline).

Identification*

I certify that if I am 18 years of age or older that in the Photo ID section of this form, to proceed with the tattoo procedure, I must submit a photo of a valid government-issued photo identification, such as a driver's license or passport. I understand that failure to provide a copy of my valid government ID may result in the cancellation of my tattoo appointment.

If I am under the age of 18, I understand that I must provide the following documents in the Photo ID section of this form to proceed with the tattoo procedure:

*A copy of my birth certificate to verify my familial connection.
*A valid government-issued identification from the parent or legal guardian listed on my birth certificate.
*A valid photo identification for myself.

I acknowledge that failure to submit the required documents, regardless of age, may result in the cancellation of my tattoo appointment. I understand that Orpheus Tattoo Studio reserves the right to refuse service to any client who fails to comply with these requirements.

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 or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

Legal Name:*

Pronoun:

Chosen name:

Address:*

Postcode:*

Date of birth:*

If you are under 18 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:*

Photo ID*

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