As Above Tattoo Consent Form

Let us do this part

Today's Date:

Fri Jun 6 2025 10:45

Practitioner:*

Please read and answer

Acknowledgement*

THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES DOES NOT ENDORSE OR RECOMMEND BODY ART PROCEDURES IN ANY FORM. This includes, but not limited to Tattooing, Body Piercing, Branding, Scarification, Cosmetic Tattooing, Permanent Makeup, Micropigmentation and Dermopigmentation.

Influence*

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

Design*

I acknowledge that the artist will show me my design on paper upon my arrival, and stencil it onto me before we begin the tattoo procedure. It is my responsibility to point out any incorrect spellings of names, wrong dates, information that is specific to me, etc. before we begin so that if needed the design can be altered.

Permanence*

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.

Conditions/Adverse Reactions*

I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication or acne medication, such as Acutane. 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 necessary. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo.

I have disclosed any information about a medical condition I have that may affect the healing of my tattoo, such as: eczema, psoriasis, rashes, acne, scarring/dermatographia/keloids, freckles, moles or sunburn in the area to be tattooed. I acknowledge that without proper aftercare, infection is always possible and I will follow all aftercare instructions I was given by my Body Artist. I acknowledge that it is not reasonable for the Artist to determine whether I may or may not have an allergic reaction to the pigments or products used during the process of my tattoo and I will disclose any known allergies to products that may be used beforehand.

Details:

Health Risks*

I acknowledge that it is possible to become infected with Hepatitis B, Hepatitis C, HIV or any other blood-borne disease with any procedure that involves exposure to blood products or instruments contaminated with blood products. In addition, I understand that an individual cannot donate blood for 12 months after having any body art procedure, and cannot donate plasma for 3 months after having any body art procedure.

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 Body Artist upon completion of form.)

Details:

Aftercare*

I have been provided with aftercare instructions either verbally or printed by my Body Artist. (All aftercare instructions will be given at the end of each session, if you would like to know the aftercare before beginning the tattoo, please ask your Body Artist directly.

Legal*

I agree to reimburse each of the Artists and As Above Tattoo for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or As Above Tattoo and in which either the Artist or As Above Tattoo is the prevailing party. I agree that the that the courts of New York in The United States shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.

Waiver*

I waive and release to the fullest extent permitted by law each of the Body Artist and As Above Tattoo from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns 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 Body Artist or As Above Tattoo, or otherwise. I will be provided a copy of this consent form via the email address I provide.

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 Artists and As Above 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:*

Address:

Postcode:

Date of birth:*

You must be 18 or older

Phone #:*

Email:*

Social Handle:

If you don't mind us tagging you in photos online

Signature:*

Sign above or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:

Email:

Address:

Photo ID*

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