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Adult Tattoo Consent Form

Let us do this part
Today's Date:
Wed May 8 2024 11:06
Practitioner:*
Please read and answer
*
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 things the blood I have advised my
tattooer. I am not pregnant or nursing. I am not under the influence of drugs or alcohol.
*
I do not have 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. If I have any type of infection or rash anywhere on my
body, I will advise my tattooer.
*
I acknowledge it is not reasonably possible for the representatives and employees of this
tattoo shop 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 have received
aftercare instructions and I agree to follow them while my tattoo is healing. 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 my exist between any tattoo as selected by
me and as ultimately applies 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 preform the tattoo procedure.
Y
N
*
Have you been told to quarantine/isolate by a health care provider or the health department?
Have you have face-to-face contact for 10 or more minutes with someone who has had COVID-19?
Are you currently:
Experiencing a fever?
Cough, shortness of breath?
New loss of sense of taste/smell?
Vomiting or diarrhea within the past 24 hours?
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
Phone #:*
Email:*
Signature:*


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