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Heavy Hearts Tattoo - New Client Form

Let us do this part
Today's Date:
Thu Jan 9 2025 07:04
Please read and answer
 
Location of tattoo on body*
 
 
Colors of ink being used
 
 
Name of Artist*
 
Y
N
Health*
DO YOU HAVE:
- a fever
- flu-like symptoms
- shortness of breath
- allergies
- bloodborne pathogens
- transmittable diseases
- recent illnesses

(It' okay if you do, we just need to know for our and other's safety).
Please list them here and speak to your artist
Details:
 
Y
N
Health*
DO YOU HAVE:
- diabetes
- epilepsy
- hemophilia
- a heart condition
- take blood thinning medication.
or 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 antibiotics. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo.

Please alert your artist if you answer yes to any of these questions
Details:
 
Y
N
Eaten*
Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.
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, 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*
TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and Heavy Hearts Tattoo from all liability whatsoever, for any and all claims or causes of action that I 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.
Healing*
After receiving my tattoo, my artist and Heavy Hearts Tattoo will give me instructions on the care of my tattoo while it's healing and I 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 unless otherwise stated by my artist. I'm aware that aftercare instructions are available in the FAQ section of Heavy Hearts website.
Influence*
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.
Spelling*
Neither the Artist nor Heavy Hearts Tattoo 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.
Permanent*
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.
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 Heavy Hearts Tattoo.
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.
Name:*
Date of birth:*
Phone #:*
Email:*
Signature:*


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