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Tattoo Consent Form

Let us do this part
Today's Date:
Tue Apr 29 2025 06:06
Practitioner:*
Tattoo Placement (arm, leg, etc...):
Tattoo Design:
Artist signature:*


Tattoo Consent Form
Please read and answer
Y
N
*
Have you ingested anticoagulants (such as heparin or warfarin), antiplatelet drugs, or nonsteroidal anti- inflammatory drugs (NSAIDS) (such as aspirin, ibuprofen, etc.) in the last 24 hours?
Y
N
*
I will be sure to eat within 4 hours
of my appointment. I will bring my
own refreshments if needed.
Y
N
*
Do you have any allergies?

Do you have any allergies or adverse reactions to dyes, pigments, latex, iodine, or other such products?
Details:
 
Y
N
*
Are you prone to fainting or seizures? Do you have hemophilia, epilepsy, a history of seizure, fainting, narcolepsy, or other conditions that could interfere with the body art procedure?
Details:
 
Y
N
*
Do you have any communicable diseases (i.e., hepatitis A, hepatitis B, HIV, or any other disease that could be transmitted to another person during the procedure)?
Details:
 
Y
N
*
Do you have any medical or skin conditions
that may interfere with the tattoo procedure
or healing? (Such as epilepsy, hemophilia,
heart condition(s), cystic acne, etc.)
Details:
 
*
I am not pregnant or nursing.
*
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.
Y
N
*
I understand the risks of tattooing, known
or unknown, can lead to injury such as,
but not limited to:

Body art can cause swelling, bruising, discomfort,
bleeding, and pain;
Body art can cause allergic reactions;
Body art can cause irreversible changes to the human body; and body art has a risk of infection.
*
I will make sure I leave this shop fully
informed on how to care for my tattoo
and will follow the instructions properly.
Any touch up work needed due to my
own negligence will be done at my own
expense.

I am voluntarily obtaining services of my own free
will and volition

I have had the opportunity to read and understand this consent form ,

I have the ability to ask questions about the tattoo


I have received and understand written and verbal aftercare.
Y
N
*
I have informed the tattoo artist of any
and all medical or skin conditions I may
have that would interfere with the
tattooing procedure or healing.
*
I acknowledge that if I have any skin
treatments or skin altering procedures,
such as, but not limited to, laser hair
removal or plastic surgery it may result
in adverse changes in my tattoo
*
I waive to the fullest extent permitted by
law any person at this place of business
from all liability whatsoever. This includes
personal injury and direct and/or
consequential damages that may result
or arise from the tattoo application or
procedure.
*
I acknowledge that a tattoo is permanent
and tattoo removal is a surgical procedure
that may result in scarring and/or
disfigurement.
Y
N
*
Do you have diabetes, high blood pressure, heart condition, heart disease, or any other conditions that could interfere with the body art procedure?
Y
N
*
I acknowledge that I am at least 18 years
of age or 16 years of age with parental
consent and that all information on this
form is accurate. I have been given the
full opportunity to ask any and all
questions and they have been answered
to my full satisfaction. I voluntarily
consent to the tattoo procedure without
duress or coercion.
 
Tattoo Artist Section*
Expiration date, brand, color, batch and/or lot number of all inks used in the body art procedure
 
 
Tattoo Artist Section*
Expiration date and batch and/or lot number of all needle cartridges used in tattoo service.
 
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.
Name:*
Address:
Postcode:
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:*
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.