Tattoo Consent Form

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Let us do this part

Today's Date:

Fri Apr 19 2024 03:47

Practitioner:*

Royal Gothic Tattoo Studio Consent Form

Please read and answer

Over 18?*

Are you over the age of 18?

Payment*

As we can no longer take cash do you confirm that you have transferred the required payment for your tattoo, or that you will transfer the required payment before attending your appointment?
Do you also accept that if this payment is unable to be processed then your tattoo cannot be completed?

Eaten*

Do you agree to eat a good breakfast before coming to your appointment. Please note that as food cannot be eaten in the studio it is now more important that you eat well before attending 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:

Covid-19*

I confirm that I will complete or have completed the COVID-19 release form sent alongside this tattoo consent form.

Appointment Preamble*

I confirm that I have read the "Appointment Preamble" sent to me by my artist, and I agree to follow the instructions given to me therein.

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:

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Photo ID*

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