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Tattoo Consent

Let us do this part

Today's Date:

Wed Dec 31 2025 12:20

Practitioner:*

Placement of Tattoo Body Location:*

Tattoo Description/Imagery :*

Tattoo Price:*

Brand(s) of needle(s):*

Needle(s) batch/lot#:*

Needle(s) expiration date(s):*

Brand of Ink(s):*

Ink(s) Batch and/or lot#:*

Ink(s) Expiration date(s):*

Artist signature:*

Please read and answer

Tattoo Permanence*

I understand that my tattoo is permanent.

Removal*

I Understand a tattoo can only be removed with a surgical procedure not offered by Reverie.

Removal Pt.2*

I understand effective tattoo removal may cause permanent scarring and disfigurement.

Allergies*

I acknowledge it is not reasonably possible for Reverie representatives to determine whether I am allergic to the pigments or processes used during my tattoo, and I agree to accept the risk that such a reaction is possible. I understand I may have an allergic reaction to products used during my tattoo including, but not limited to latex, ink, and disinfecting products. I have informed my tattoo artist of any known allergies.

Details:

Nausea *

I understand there is a chance that I may experience nausea, light-headedness, dizziness, and/or fainting during or after

Remaining still*

I understand that I must remain as still as possible during my tattoo procedure and if I move during my tattoo procedure, it may alter the outcome of my tattoo. I understand that if my movement alters the outcome of my tattoo that neither Reverie or the Artist are responsible.

Refunds*

I understand that Reverie does NOT offer REFUNDS for TATTOOS or TATTOO DEPOSITS.

Hand/Finger/Feet/Toes*

I understand that tattoos on fingers, palms, toes, pads of feet, sides of feet or hands are more likely to fade/fall out.

Design*

I have reviewed and approved the draft of my design. I understand the final tattoo on my body may deviate slightly from the draft in color and design. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.

Questions?*

I acknowledge that I have been given the full opportunity to ask any questions that I might have about the tattoo procedure and that all of my questions have been answered to my full satisfaction.

Complications*

Please List any Complications that may occur during Tattoo Procedure

Eaten?*

Have you eaten in the past 4hrs? You must eat and be hydrated before a tattoo.

Healing*

I understand that I am solely responsible for the care of my tattoo after leaving Reverie. I understand that neither the tattoo artist nor Reverie can be held responsible for the care or condition of my tattoo when leaving Reverie. 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 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 and at my own risk.

Spelling*

Neither the Artist nor Reverie Tattoo Is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the design.

Touch ups*

I understand that Reverie offers one free touch up in the first year. Unless negligence from improper after care, then client will pay normal shop rate. Cover ups may take multiple sessions and are not considered a touch up.

Are you 18 or older?*

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 of the shop reasonably necessary to perform the procedure.

Release*

I acknowledge that I understand the risks associated with the tattoo procedure and hereby hold harmless and release Reverie and any Reverie representative from any and all liability.

Pregnant?*

Are you pregnant or breastfeeding?

Under The Influence *

Are you under the influence of alcohol and/or drugs?

Details:

Communicable disease or BBP*

Do you have any of the following in the past 12 months?
Jaundice, Hepatitis A, B, Or C, HIV/AIDS, Diabetes, Keloid, Heart Condition, Heart Disease, Epilepsy, Seizures, Eczema, Hemophilia, Psoriasis, Tuberculosis, High Blood Pressure or any other condition that can interfere with the procedure?

Details:

Ingestion in last 24*

Have you ingested anticoagulants (such as heparin or
warfarin), antiplatelet drugs, or nonsteroidal antiinflammatory drugs (NSAIDS) (such as aspirin, ibuprofen,
etc.) in the last 24 hours?

Medication *

Have you ingested any medication that can inhibit the
ability to heal a skin wound?

Details:

Allergies*

Do you have any allergies or adverse reactions to dyes,
pigments, latex, iodine, or other such products?

Details:

Skin History*

Do you have a history of skin diseases that might inhibit
the healing of the body art procedure?

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 or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

Name:*

Address:*

Postcode:

Date of birth:*

If you are under 18 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Photo ID*

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