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Tattoo

Let us do this part
Today's Date:
Mon May 6 2024 08:04
Practitioner:*
Location On Body:*
Description of Tattoo:*
Quoted Time or Cost:*
I release and hold harmless Good Form Piercing & Tattoos Ltd and its employees from all manner of liabilities, claims, damages, or legal action arising from or connected in any way with my tattoo, or the procedures and conduct to perform my tattoo.

I allow Good Form Piercing & Tattoos Ltd to tattoo me. I understand that this procedure will be
performed under proper aseptic conditions, using sterile and/or disposable implements with the highest
quality ink. I understand that infections and/or irritation can occur as a result of improper care and/or poor
hygiene. I agree to follow the procedures as instructed by my artist and/or the aftercare pamphlet I have been
provided with for the recommended period of time.

I further understand that although Good Form has taken extra measures to reduce the risk of transmission of the Coronavirus/Covid 19 (including, but not limited to; not allowing any staff or client that display symptoms to enter), due to the close nature of the procedure, no guarantee can be made that Covid will not be transmitted during an appointment. I understand the procedures taken to protect me, and am comfortable with this level of risk.
Please read and answer
Price Quote*
I confirm that I have received an estimated price or time quote for this service, and have agreed to this total. I understand that due to the nature of tattoos, this price might fluctuate slightly and is not an exact quote. The quote is also listed at the top of this waiver for reference.
Y
N
Covid Check*
Are you experiencing any cold or flu symptoms?
Have you been asked to isolate in the past 14 days?
Have you been in direct contact with anyone who has?
Y
N
Have you had something substantial to eat in the last 4 hours?*
Y
N
Do you have any Allergies? If yes, please list them.*
Including, but not limited to: medications, adhesives, foods and /or natural products.
Details:
 
Y
N
Health*
Are you pregnant or nursing? Do you have any medical conditions that may impact your healing? (Hemophilia, diabetes, etc) Are you on any medications that could affect your healing? (immunosuppressants, accutane, etc)
Details:
 
Y
N
Questions?*
Has Good Form given you a chance to ask any and all questions you may have, and answered them to your full satisfaction?
Y
N
Duress*
I am sober and of sound mind, with no influence of drugs or alcohol I am voluntarily choosing to be tattooed by the artist, without any duress or coercion from my artist, or any third party.
Permanent*
I understand 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 to its previous state.
Photography
I release the rights to any photographs taken of me and/or my new tattoo, and give consent in advance to the reproduction of these photos in physical prints, online/social media use, or for portfolio purposes.
Y
N
Instagram*
If you have an Instagram account, can we tag you in a photo if/when we post it? If yes please leave us your handle!
Details:
 
Y
N
Design*
I hereby agree that the design and placement of my tattoo has been thoroughly agreed upon between myself and my tattoo artist, and it is henceforth my responsibility to notify and clarify to my artist of any changes in placement or design are desired.
Script
If my tattoo includes ANY script (dates, initials, symbols, and/or words) I acknowledge that it is my responsibility to confirm all spelling, context, meaning, orientation, and translation is correct before the tattoo process begins.
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.
Legal Name:
Pronoun:
Chosen name:
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.
Enter passcode to submit: