Tattoo studio
Tattoo Consent Form
Photo ID Upload
Government Issued required. (Drivers license, State ID,Military ID, Passport)
Name
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Age
Birth Date
Phone Number
Email
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Address
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City
State / Province
Postal / Zip Code
Emergency Contact
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Phone Number
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Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
Yes
No
FEMALE ONLY: Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
Yes
No
Do you have any skin conditions?
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
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Acknowledgment, Waiver of Release and Liability
I indemnify and hold Arcane Tattoo Studio harmless against any claims, expenses, damages, and liabilities. I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows: If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medicine which thins the blood I have advised my tattooer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs. I have disclosed medical or skin conditions such as but not limited to: acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. I acknowledge it is not reasonably possible for the representatives of this tattoo establishment to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible. I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo. I agree to follow aftercare instructions while my tattoo is healing. I understand there are links online regarding aftercare. I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin. I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo. I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo. I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure. I fully understand THE TATTOO ARTIST DOES NOT ACT AS A MEDICAL PROFESSIONAL. Any suggestions made to me are NOT to be construed as or substituted for advice from a medical professionals.I understand that this procedure is a permanent change to my skin and body. I allow my tattoo and myself to be photographed video recorded and be used for Tattoo Shop portfolio , social media advertisements and online content. I acknowledge that the Tattoo Shop does not offer refund.
I confirm that the information I provided in this document is accurate and true.
Signature
Signed Date
Submit