←

Repeat Client

Let us do this part

Today's Date:

Thu Aug 21 2025 08:46

Practitioner:*

Please read and answer

Are you currently experiencing any flu-like symptoms or taking prescription antibiotics?*

Are you currently pregnant or nursing?*

Have you eaten within the past four hours?*

Have you been diagnosed with or had recent exposure to any known bloodborne illnesses?*

Examples of these diseases include, but are not limited to, HIV/AIDS, Hepatitis B, Hepatitis C, Malaria & Syphilis

Prior to getting my tattoo, I will disclose the following:*

I have Diabetes, Anemia, Hemophilia, Epilepsy, or a heart condition.
I have recently had a blood transfusion.
I have recently gone or am currently going through Cancer treatments.
I have a known skin condition/allergy.
I am prescribed blood-thinning medication.

I am not under the influence.*

I acknowledge that I am not currently impaired by drugs or alcohol, nor am I being tattooed under duress or coercion.

I understand the risks.*

I acknowledge that, while the artist and the studio will do their best to provide me with a comfortable experience in a professional setting, there are still potential risks associated with getting a tattoo. These can include redness/rashes, infection, allergic reactions, burning/swelling, and scars/keloids.

I acknowledge that I have had the opportunity to make adjustments and edits throughout the creation process of my tattoo and am thoroughly satisfied with the stenciled design.*

Prior to being tattooed, I will alert the artist of any last-minute changes I would like to make, including the size and placement of the stencil. I will also confirm that applicable spellings, dates, and symbols are correct.

I will comply with the aftercare instructions provided to me by my artist.*

I will notify the studio if I have any concerns throughout the healing process and acknowledge that, if any touchups are required due to my own negligence, they will be at my personal expense.

I have read and understand the following waiver.*

I WAIVE AND RELEASE TO THE FULLEST EXTENT PERMITTED BY LAW both the Tattoo Artist and The FlipSide Tattoo Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assignees may have for personal injury or otherwise. This includes any direct and/or consequential damages which result or arise from my voluntary decision to be tattooed.

I acknowledge I have read the following Legal Agreement.*

I agree to reimburse the above listed Tattoo Artist and The FlipSide Tattoo Studio for any attorneys’ fees and additional costs incurred from any legal action I bring against the Artist or Studio in which either is the prevailing party. I agree that the courts of Illinois shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or relating to this agreement.

I confirm that all of my questions have been answered to my satisfaction.*

I understand that I am signing a legal contract and confirm that I have had adequate opportunity to receive clarification on any items of concern both within and outside the confines of this document.

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.

Name:*

Date of birth:*

You must be 18 or older

Phone #:

Email:

Signature:*

Sign above or type signature: