TATTOOS

First name

Last name

Birthday

Day

Month

Year

Phone

optional

Email

Address

Emergency contact/Name and Number

Upload Your ID

Body part to be tattooed

Your Artist

You are about to requested a tattoo treatment that involves minor breakage of the skin surface with a needle. Please read the following information carefully and answer some questions of the consent form prior to having your tattoo.

Do you have any heart disorders?

yes

no

Do you suffer from any conditions that affects your immune system?

yes

no

Do you have Diabetes?

yes

no

Do you suffer from Hemophilia or any other blood clotting disorder?

yes

no

Do you have any known blood borne virus? (e.g. Hepatitis B/ C/D or HIV)

yes

no

Have you ever had any problems with skin healing? (e.g. eczema or psoriasis)

yes

no

Are you prone to fainting or dizziness?

yes

no

Are you pregnant or breastfeeding?

yes

no

Do you suffer from high/low blood pressure?

yes

no

(If yes, please indicate which below)

Do you have epilepsy/seizures?

yes

no

If Yes, how is it controlled (please give details below)

Have you ever had any allergic reactions to plasters, latex, metals, creams etc.

yes

no

(If yes, please indicate which below)

NOTES / ANY OTHER CONDITIONS NOT LISTED

(if Yes, please give details)

THERE ARE RISKS INVOLVED IN GETTING A TATTOO, THAT INCLUDES:

REDNESS AND SWELLING TO THE AREA

FAINTING OR TIREDNESS

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Tattoo Consent Form