Consent Form - State Tattoo Co

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CONSENT TO TATTOO PROCEDURE

Name(Required)

First Last

Date(Required)

MM slash DD slash YYYY

Date Of Birth(Required)

MM slash DD slash YYYY

Age(Required)

Please enter a number greater than or equal to 18.

Phone(Required)

Return Client?(Required)

How Did You Hear About Us?(Required)

Who Referred You?(Required)

Referral Source(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Consent to Tattoo Procedure I acknowledge by checking each point and signing this agreement that I have been given the full opportunity to ask any and all questions which I may 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:

Consent(Required)

If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medication which thins the blood i have advised my tattooer.(Required)

Consent(Required)

I am not under the influence of alcohol or drugs. I am not pregnant or nursing.(Required)

Consent(Required)

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.(Required)

Consent(Required)

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 reaction is possible.(Required)

Consent(Required)

I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my tattoo. I have recieved aftercare instructions and I agree to folow 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.(Required)

Consent(Required)

I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied 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.(Required)

Consent(Required)

I understand that if I have any skin treatments, laser hair removal, plastic surgery or any other skin altering procedures, it may result in adverse changes to my tattoo.(Required)

Consent(Required)

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.(Required)

Consent(Required)

I acknowledge I am over the age of eighteen (18) 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 shop reasonably necessary to perform the tattoo procedure.(Required)

Consent(Required)

I fully understand THE TATTOO ARTIST DOES NOT ACT AS A MEDICAL PROFESSIONAL. Any suggestions made to me are NOT to be construed as or substituted for advice from a medical professional.(Required)

Please Upload a Valid form of ID here so we can Verify your Age:(Required)

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Max. file size: 50 MB.

Client Signature(Required)

Tattooer Signature