Consent Form

Let us do this part

Today's Date:

Thu Sep 19 2024 04:29

Practitioner:*

Tattoo location on body:*

Description of tattoo:*

This is an informed consent form that has been prepared to help inform you of the potential benefits and risks of permanent tattoos. It is important that you read this information carefully and discuss fully with your practitioner before proceeding with treatment.
It is essential that you are aware of your right to have a second opinion and you are encouraged to ask any questions that come to mind throughout the entirety of the process.

The tattoo can take various time periods depending on complexity, body part, and individual factors. I have been informed that the highest standards of hygiene are met and that sterile, disposable needles and pigment containers are used for each individual client, procedure and visit.

I understand that I may need a touch-up depending on how my tattoo heals - I have been informed this is free of charge should I follow aftercare directions properly, and I must make this appointment within 3 months of receiving my tattoo. I am also aware touch-ups on the hands and feet are not free and are charged at a rate of £40.
I understand that some skin types accept pigment more readily and no guarantee on exact colour can be given. I understand the actual colour of the pigment may be modified slightly, due to the tone and colour of my skin.
I fully understand and accept that non-toxic pigments are used during the procedure and that the tattoo may fade over a period of months/years as my body tries to break down the pigment.

RISKS AND SIDE EFFECTS: As with any procedure there are potential risks and complications associated. You must be aware of all the following risks before proceeding with your tattoo appointment. You must fully discuss any questions with your tattoo artist.

Common complications and risks include: pain or discomfort either during or after the procedure. It is common for the skin to appear red and swollen afterwards, you also may have some minor bleeding, bruising or scabbing, these effects can last up to 14 days but may last longer, it takes up to 6-8 weeks for tattoos to heal.

Uncommon complications and risks include: Skin infection (cellulitis) which can present as hot, red, shiny skin, there may be pus and you may also feel generally unwell. Infection is uncommon especially if you follow the aftercare advice. In the event of infection, you must see your doctor as soon as possible.
Some people may faint or feel faint with needles, if you feel unwell during treatment you must inform your practitioner as soon as possible.

Rare complications and risks include: unsightly hypertrophic or keloid scarring, delayed inflammatory nodule (granuloma) formation, skin reaction to local anaesthetic cream and allergic reaction. Allergy can present as swelling, red rash and sometimes blistering, occasionally clients may develop an allergic reaction to the tattoo pigment used. Rarely, anaphylactic reactions can occur. In the event of an anaphylactic reaction, you would need emergency medical attention. In the case of severe allergic or inflammatory reaction permanent scarring may result.

I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice. This includes advice about:
- the risks inherent in the procedure
- the risks specific to me
- any follow-up appointments that may be required

PHOTOS AND VIDEOS: I agree to and authorise the taking of clinical photographs and videos.

CONSENT: To my knowledge, I do not have any physical, mental or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have the tattoo done now. I agree to follow all pre-appointment and post-appointment instructions as provided and explained to me by the tattoo artist. Failure to do so may jeopardise my chances for a fully saturated tattoo. I can confirm that I have received a copy of aftercare details. I have been informed of the nature, risks, and possible complications and consequences of tattoos.

I have been asked what information I want and would need in order to make an informed decision. I have been given the opportunity to discuss my desired outcome fully in order for me to make an informed decision.

I certify that I have read the above consent and that I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. No new information has become available that affects my decision to have the tattoo or my decision to consent. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures

Please read and answer

Allergies

(Please select Y for yes or N for no for the following questions).
Do you suffer from any known allergies? If so please specify which.

Details:

Medication

Are you currently taking any medication? If so please specify which.

Details:

Bloodbourne Pathogens*

Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses?
(It's okay if you do, we just want to know for our and other's safety).

Risks*

I have been 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, 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.
In the case of UV ink I am also aware that the tattoo may be irritated when exposed to direct sunlight for extended periods of time.

Healing*

The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it's healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.

Influence*

I agree I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion.

Health*

I agree I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I do not have any other condition that may interfere with the application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the preventive anti-biotics. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo.

If any of the above do apply to me (tick no and specify which), I have sought the appropriate medical advice and approval prior to my appointment. I am also aware the tattoo process and healing can cause complications for any existing medical conditions I may have.

Details:

Spelling*

I agree that neither 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 any flash (design) sheets. I have checked and approved that all spelling and design elements are correct to my own specifications.

Permanent*

I am aware a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means.

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.

Fading*

I understand that 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, which occurs during the natural ageing process.
In the case of UV tattoos, I understand that the UV effect may not be permanent and may also fade or disappear over time as my skin breaks down the pigment.

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. (If you do not tick this provision, please advise your Artist).

Additional information

Is there anything else you would like to make us aware of so we can make your appointment as comfortable as possible for you? (This is confidential between yourself and your artist).

Details:

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:*

Pronoun:

Chosen name:

Address:*

Postcode:*

Date of birth:*

You must be 18 or older

Phone #:

Email:*

Signature:*

Sign above or type signature:

Photo ID

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