Tattoo Consent Form
Let us do this part
Today's Date:
Tue Apr 21 2026 06:27
Practitioner:
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-- Select --
Tierra M.
Tattoo Location:
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Tattoo Price:
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Signature:
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Please read and answer
Y
N
Do you have Flu like symptoms?
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IF YOU HAVE:
- a fever
- flu-like symptoms
- shortness of breath
YOU NEED TO NOTIFY A STAFF MEMBER IMMEDIATELY.
Y
N
Eaten
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Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.
How did you hear about us?
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Y
N
Bloodbourne Pathogens
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Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses? (It' okay if you do, we just want to know for our and other's safety).
Risks
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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.
Waive
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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, 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 Artist or the Tattoo Studio, or otherwise.
Healing
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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.
Influence
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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.
Health
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I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. 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 am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo.
Spelling
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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.
Fading
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Variations in color/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.
Permanent
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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.
Legal Action
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I agree to reimburse each of the Artist and the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of [FLORIDA] in [USA] 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.
Questions
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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 Artist and the Tattoo Studio.
Y
N
Photography/Content
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I release all rights to any photographs and/or videos taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form.
Aftercare
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AFTERCARE:
If you received 2nd skin (Saniderm or Derm Shield), you can leave it on for NO MORE THAN 24 hours.
When removing the 2nd skin, do so under warm running water such as in the shower. Gently lift and pull away the bandage, if it is stubborn use unscented antibacterial soap to help remove.
Once 2nd skin is FULLY REMOVED, continue on to the next set of instructions.
Handwash the tattoo with unscented antibacterial soap. DO NOT use fragranced soap or lotions. Once the tattoo is washed, pat dry with a CLEAN paper towel and let tattoo continue to air dry for 10 minutes BEFORE applying any plain white, unscented body lotion.
Aquaphor is NOT recommended.
Keep your new tattoo out of the sun for 3-4 weeks minimum (4 weeks recommended). Sunscreen can be applied AFTER 4 weeks.
DO NOT submerge your new tattoo in any bodies of water (including bathtubs) for a minimum of 2 weeks (4 weeks is recommended).
YOUR TATTOO IS A HEALING WOUND AND SHOULD BE TREATED AS SUCH. BODIES OF WATER CONTAIN BACTERIA WHICH COULD ENCOURAGE AN INFECTION OR DAMAGE YOUR TATTOO.
**INITIALS ARE REQUIRED IN BOX AFTER READING THESE AFTERCARE INSTRUCTIONS**
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:
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Postcode:
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Date of birth:
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You must be 18 or older
Age:
Phone #:
*
Email:
*
Sign up for our newsletter
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 #:
Physician Information
Enter your physician or medical practitioner's contact details.
Name:
Contact:
Address:
Photo Identification
*
Please take photo(s) of your government issued photo IDs and related paperwork
Please take photo(s) of your government issued photo IDs and related paperwork.
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