Tattoo Consent Form

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Let us do this part

Today's Date:

Tue Oct 21 2025 07:43

Practitioner:*

Artist signature:*

Royal Gothic Tattoo Studio Consent Form

Please read and answer

Over 18?*

Are you over the age of 18?

Eaten*

Have you eaten prior to your appointment?

Medical Checklist*

Do you confirm the following?:

- 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.

-I do not have a mental impairment that may affect my judgment in getting the tattoo.

If you suffer from any of the above, please provide details below

Details:

Do you suffer from any of the following?

If yes please provide details below,
(It is important for your artist to know so that they can provide the best care for you and your tattoo)

ECZEMA, PSORIASIS, ACNE, CELLULITIS OR OTHER SKIN CONDITION - more prone to skin infections

HEART DISEASE - more prone to heart complications from blood infections

HIGH/LOW BLOOD PRESSURE - can cause feeling light headed

HAEMOPHILIA OR OTHER BLEEDING DISORDERS - may result in poor clotting/healing

EPILEPSY/SEIZURES - medication can cause side effects and may result in fitting

DIABETES - can reduce healing properties of the skin resulting in infection

HEPATITIS A B OR C - poses a risk to the Client

HIV - poses a risk to the client

CANCER/CANCER TREATMENTS- having a reduced autoimmune system risks being more prone to serious infection and/or affect healing

ALLERGIES - may result in reaction to ink/ other products

PREGNANT - any infection may affect unborn child

BREAST FEEDING - possible infection is a risk to the baby

ON MEDICATION - side effects may affect healing and recovery from treatment

Details:

Bloodbourne Pathogens*

Do you confirm that you have no bloodbourne pathogens, transmittable diseases or recent illnesses? (It' okay if you do, we just need to be aware for our own and other's safety).

Details:

Risks*

I confirm that I understand there are inherent risks associated with getting a tattoo and I still wish to proceed with the tattoo application and freely accept and expressly assume any and all associated risks.

Waive liability*

I agree to waive and release to the fullest extent permitted by law each of the Artist and the Studio from all liability whatsoever for any and all claims or causes of action that I may have for personal injury or otherwise. This includes any direct and/or consequential damages which result or arise from my tattoo.

Healing*

I confirm that I will accept the aftercare instructions given to me by the studio and follow these instructions while it's healing. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.

Pregnancy/Nursing*

I am not pregnant nor am I nursing a child.

Spelling*

Neither the Artist nor the Tattoo Studio is responsible for the spelling of any text that I have provided to them, and I confirm that I am entirely responsible for checking that any spellings included in the design are correct before the tattoo begins.

Permanent tattoo*

I understand and accept that this tattoo is a permanent change to my skin. I also accept that the tattoo will naturally change and fade over time and that this can e exacerbated by my not taking the appropriate steps to care for my tattoo, such as avoiding getting sun tanned or burned.

Photos*

I consent for any photographs taken of the tattoo to be used for social media or promotional purposes by the artist and studio.

Under the influence*

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.

Allergies*

Do you have any allergies that might effect getting tattooed? Please give details if answering yes.

Details:

Permanence

I understand that a tattoo is considered permanent and may only be removed with a surgical procedure.

I understand that any effective removal of a tattoo or body piercing may leave scarring.

I am not under the influence of alcohol or drugs and that I am
voluntarily submitting myself to receive body art without duress or coercion.

The body art described or shown on this form is correctly placed to my specifications. If applicable, I have also confirmed all spelling and grammar necessary in the procedure.

All questions about the body art procedure have been answered to my satisfaction, and I have been given written aftercare instructions for the procedure I am about to receive.

I understand the restrictions associated with this body art procedure as explained by the technician.

I understand that any medical information obtained will be subject to the federal Health Insurance Portability and Accountability Act of 1996
(HIPPA).

I am aware of the signs and symptoms of infection, including but not limited to, redness, swelling, tenderness of the procedure site, red streaks going from the procedure site towards the heart, elevated body temperature, or purulent draining from the procedure site.

I understand there is a possibility of getting an infection as a result of receiving body art.

I will seek professional medical attention if signs and symptoms of infection occur.

I agree to follow all instructions concerning the care of my body art procedure and that any touch-ups needed due to my own negligence will be done at my own expense

I understand that there is a chance that I might feel lightheaded or dizzy during or after being tattooed.

I agree to immediately notify the artist in the event I feel lightheaded, dizzy, and/or faint before, during or after the procedure.

Variations in color design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time colors and the clarity of the tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.

Up on signing this release form I agree that I have been fully informed of the risks of body art including but not limited to infection, scarring, and allergic reactions to items associated with body art procedures.
Technician will not perform the body art procedure if you fail to complete or sign this form. Further, technician may decline to perform a body art procedure if the client has any identified health conditions. Having been informed of the potential risks associated with this body art procedure, I still wish to proceed with the body art application and I assume any/all risks that may arise from body art.

All of the above information will be kept in the strictest confidentiality

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:

Address:*

Postcode:*

Date of birth:*

You must be 18 or older

Gender:

Nationality:

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 #:*

Photo ID*

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