PERSONAL INFO Name * Instagram Phone Number * Tattoo Date MM DD YYYY HEALTH DECLARATION Are you over 18 years of age? * Yes No Have you eaten in the last 4 hours? * Yes No Have you consumed alcohol or drugs within the last 12 hours? * Yes No Have you taken any medication that thins the blood within the last 24 hours? * Yes No Do you have allergies to latex, dyes, metals or other? Do you have any conditions such as hemophilia, epilepsy, diabetes, or heart conditions? Do you have any skin conditions? Do you have any communicable diseases that can be transmitted through blood? Have you had any issues with healing from previous tattoos? Are you pregnant or nursing? * Yes No Do you faint easily? * Yes No CONSENT FORM ✦ I acknowledge and accept that tattoos are permanent and can involve risks such as infection, allergic reactions, and skin irritation. I accept these risks as part of the procedure. ✦ I am aware that the tattoo artist cannot predict or be held responsible for my individual body’s reaction to the tattoo process. ✦ I recognize that tattoos may not perfectly replicate the initial sketch and accept the unique outcome of the art. ✦ I confirm that I am obtaining this tattoo service of my own free will and have had the opportunity to ask questions about the procedure. ✦ Furthermore, I commit to following the aftercare instructions provided by the tattoo artist, either in written or verbal form. ✦ I recognize that neglecting these guidelines could lead to complications in the healing process and potentially affect the quality of the tattoo’s healing. By submitting I hereby affirm that all information I have provided in this form is accurate and true to the best of my knowledge. I agree to adhere to all the terms and conditions outlined in this consent form and understand the implications of failing to comply with them. Thank you!
