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Consent Form
Artist
Client Information
Name
Date of Birth
Phone Number
Please upload your photo ID
Please obscure all information except for the date of birth, name, and photo before upload.
Pre-Procedure Questionnaire
Have you consumed alcohol in the last 8 hours?
Are you currently taking any prescribed medications?
Have you taken aspirin, ibuprofen or blood thinners in the last 24 hours?
Are you pregnant or breast feeding?
Do you have any heart diseases, vascular problems, or issues with blood pressure?
Do you have epilepsy, hepatitis, HIV, AIDS or any other communicable disease?
Do you have diabetes?
Are you prone to heavy bleeding?
Do you have a tendency to faint?
Are you allergic to latex or adhesive?
Please list any factors that could affect your healing process.
Acknowledgment and Waiver
I acknowledge by signing this consent form that I have read and agree to the following
  • Medical Conditions and Skin Sensitivities: I do not have any medical or skin conditions such as, but not limited to, acne, scarring (Keloid), eczema, psoriasis, moles, or sunburn in the area to be tattooed that may interfere with the tattoo. I will inform my tattoo artist of any infection or rash anywhere on my body.
  • Understanding of Risks: I willingly submit to these procedures with a full understanding of possible complications, including, but not limited to, infection, allergic reaction, or rejection of the ink.
  • Allergic Reactions: I acknowledge it is not reasonably possible for the artist to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo and agree to accept the risk.
  • Text Accuracy: I am responsible for the correct spelling, grammar, and punctuation of any text included in my tattoo.
  • Appearance Variation: I am aware that the final tattoo on the skin may differ from the design drawn on paper or created digitally.
  • Non-Medical Professional Acknowledgment: I understand that the tattoo artist is not a medical professional. Any suggestions made are not to be construed or substituted for advice from a medical professional.
  • Medical Advice and Risk Assumption: If I have a medical condition or am on medication, I confirm that I have sought or had the opportunity to seek medical advice regarding getting a tattoo. I assume all risks associated with the tattoo procedure in light of my medical condition or medication.
  • Permanent Change Acknowledgment: 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.
  • Sterilization and Procedure: The sterilization method used was explained to my full satisfaction. I had the opportunity to ask questions, and all questions were answered satisfactorily. I witnessed the disposal of tattoo needle(s) into regulated sharps containers.
  • Aftercare Instructions: I have received both written and verbal Tattoo Aftercare Instructions and commit to following them strictly.
  • Age and Consent: I confirm that I am of legal age to receive a tattoo and that I have the legal capacity to give this consent.
  • Voluntary Participation: I confirm that I am receiving this tattoo voluntarily and without any coercion.
  • COVID-19/Infectious Disease: I confirm that I am not currently experiencing symptoms of, nor have I been exposed to, any infectious diseases, including COVID-19, within a medically advised quarantine period.
  • Photography/Artwork Rights: I consent to the use of images of my tattoo for the studio's portfolio and marketing purposes.
  • Release and Discharge: I release and forever discharge the artist and the studio from any and all claims, damages, and legal actions arising from or connected in any way with my tattoo or the procedures and conduct used to apply it.
Client Signature
Date of Appointment
teenytiny.tattoo.studio@gmail.com
@teenytiny.studio
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