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Tattoo Consent Form v2
Let us do this part
Today's Date:
Wed Mar 12 2025 05:42
Practitioner:*
Tattoo Location:*
Session Price inc. deposit:*
Hours booked:*
ICONYX TATTOO
72 High Street
Milton Regis
Sittingbourne
KENT
ME10 2AN
Please read and answer
Y
N
Do you have Flu like symptoms?*
IF YOU HAVE:
- a fever
- flu-like symptoms
- shortness of breath

YOU NEED TO NOTIFY A STAFF MEMBER IMMEDIATELY.
Y
N
Eaten*
Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.
Individual Consent*
I declare that I give my full consent to the tattooing being carried out by the practitioner. I confirm that potential complications, e.g. infection and swelling, for the procedure undertaken, and aftercare instructions have been explained to me. An aftercare advice sheet containing more detailed information has been given to me and I agree that it is my responsibility to read this and follow the instructions on it, until the site has healed. Available at www.iconyxtattoo.co.uk/aftercare. I confirm that the above information provided by me for this consent form is correct to the best of my knowledge, that I am over the age of consent for this procedure (i.e. 18 years old for tattoos) and that I am not currently under the influence of alcohol or drugs.
Spelling*
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 the flash (pre-designed art work) sheets.
Fading*
Variations in colour/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 natural dispersion of pigment under the skin.
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.
Risk*
I acknowledge the know risks;
⦁ Scaring
⦁ Blood Poisoning
⦁ Localised Infection
⦁ Allergic Reaction to Pigment
⦁ Localised Swelling Around The Site
⦁ Bruising
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.
 
Medical History
Suffers from any heart conditions (e.g. prosthetic heart valve/ heart valve disease/ angina/ blood pressure problems)? Suffers from epilepsy? Suffers from haemophilia/ other clotting disorders? Suffers from any known blood borne virus (e.g. Hep B, Hep C, Hep D, HIV)? Suffers from diabetes or lupus? Suffers from any problems with skin healing in the past, e.g. psoriasis, eczema? Suffers from any 'lumpy'raised scars (Keloid scars)? Suffers from any known allergic responses. e.g. plasters/ creams/ metals/ iodine/ latex/ foodstuffs/ other? Takes any prescribed medication regularly (especially any anticoagulants such as Warfarin or high dose aspirin; any immunosuppressants such as steroids)? Is the client pregnant? Prone to 'fainting attacks'? Any known/previous reaction to dye pigments?
 
More Details*
Please list any medical conditions and provide details of medication currently taken. (Please type N/A if nothing applies)
 
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:*
Pronoun:
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.