Consent form
Let us do this part
Today's Date:
Tue Jul 7 2026 07:18
Practitioner:
*
-- Select --
Blue
Tattoo Location:
*
Signature:
*
Photo Identification
*
Please take photo(s) of your government issued photo IDs and related paperwork
X
Please read and answer
Y
N
Do you have Flu or cold like symptoms?
*
IF YOU HAVE:
- a fever
- flu-like symptoms
- shortness of breath
- runny nose
- persistent cough
YOU NEED TO NOTIFY A STAFF MEMBER IMMEDIATELY.
Risks
*
That I have been fully informed of the inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risks, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks.
Y
N
Eaten
*
Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.
Y
N
Payment
*
I am cash only, please let me know ahead of our session if you need take money out
Y
N
Fainting or dizziness
*
Are you prone to fainting or dizzy spells?
Details:
Y
N
Seizures or epilepsy
*
Do you have seizures or epilepsy?
Details:
Y
N
Blood pressure / heart conditions
*
Do you have low or high blood pressure and or have a heart condition
Details:
Y
N
Autoimmune disease/ immunosupressed
*
Do you have an autoimmune disease or are you immunosupressed?
Details:
Y
N
Haemophilia
*
Do you have Haemophilia (problems with clotting blood)
Y
N
Pregnant or nursing
*
Are you pregnant or nursing?
Y
N
Medication
*
Are you taking any blood thinning medication? E.g. aspirin/warfarin
Details:
Y
N
Allergies
*
Please let me know if you're allergic to the following
○ Adhesives
○ Plasters
○ Latex
○ Witch Hazel
Or anything I need to be aware of?
Details:
Y
N
Bloodbourne Pathogens
*
Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses? (It' okay if you do, we just need to be aware)
Details:
Y
N
Health
*
Any medical conditions or medication I should be aware that you think could affect the healing and tattooing process?
Details:
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.
Spelling
*
Neither the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets. I have double checked the spelling of the tattoo
Permanent
*
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.
Healing
*
The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it's healing, and I understand them and will follow them. 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.
Fading
*
Variations in colour/design may exist between the art I have selected and the actual tattoo. I also understand that over time, the colors and the clarity of my tattoo will fade due to natural dispersion of pigment under the skin.
Y
N
Photography
Do you consent to photos / videos being taken during our session and are ok with me sharing them online? If you're ok with me taking photos / videos but don't want me to post them please let me know (if you're not comfortable with any photos / videos being taken that's ok there's no pressure!)
Y
N
Would you like a silent appointment?
Minimal to no talking and or lower music volume / no music
Details:
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:
*
Pronouns:
-select-
He/Him
She/Her
They/Them
He/Them
She/Them
He/She
He/She/They
Other
Chosen name:
Address:
*
Postcode:
*
Date of birth:
*
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-Month-
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You must be 18 or older
Age:
Phone #:
*
Email:
*
Social Handle:
If you don't mind us tagging you in photos online
Signature:
*
Sign or type signature:
Parent/Legal Guardian
I, as custodial parent or legal guardian of the above minor under -18 years of age, hereby consent to the terms and conditions set forth in this release form and I attest that all documentation I have provided is true and accurate.
Legal Name:
*
Signature:
*
Sign or type signature:
Emergency Contact
If something happens, your emergency contact might need to explain your medical history, allergies, or medications.
Name:
Phone #:
*
Enter passcode to submit: