Tattoo Consent Tattoo Consent Today's Date * Artist Name * Don EstebanMatt SmithBillyChonMadison Price Quote * Client Name * Date of birth * ID # * Phone # * Email * Tattoo Design * Location on Body * How long since you last ate? * Confirm the following by initialing each statement * I agree to tell my artist immediately if I feel lightheaded, dizzy and / or faint before, during, or after I am tattooed and/or pierced. I am not currently under the influence of alcohol or drugs. I am voluntarily choosing to get tattooed and/or pierced. It is my legal ID that I have presented as proof that I am at least 18 yrs old. I understand there is a possibility of an allergic reaction or infection. I understand there is a possibility of scarring or imperfections. I understand that tattoo inks, dyes, & pigments have not been approved by the FDA & health consequences are unknown. Please check any conditions below that apply to you: Heart Condition Diabetes Asthma Epilepsy Fainting / Dizziness Pregnant / Nursing Hemophilia Blood Thinners Bleeding Disorder Eczema / Psoriasis Melanoma Tenderness Skin Condition Scarring / Keloiding T.B.Herpes HIV Allergy to Latex Allergy to Antibiotics Allergy to Metals Allergy to Soaps Allergy to Alcohol Other Allergies? Are you on medication(s)? * Yes No If so, what medication(s)? Confirm the following by initialing each statement * I agree to follow all aftercare instructions. I am aware that any touch ups due to my own negligence will be done at my own expense. I have received contact information for the tattoo artist. I agree to contact the tattoo artist for any & all questions / concerns about my tattoo immediately. I agree to contact the tattoo artist regarding concerns, prior to seeking medical attention. Client Signature * Clear If you are human, leave this field blank. Submit
