Tattoo Consent Form

Tattoo Consent
NO ID = NO TATTOO
Address
Address
City
State/Province
Zip/Postal

Medical History

Have you been tattooed before?
Do you have a skin disease or skin lesions?
Are you Pregnant
Do you have a heart condition, epilepsy, diabetes, seizure, narcolepsy, or fainting?
Are a hemophiliac (bleeder) or on any medications that may cause bleeding or may hinder blood clotting, such as anticoagulants?
Do you have any communicable diseases? (H.I.V., A.I.D.S., HEPITITIS)
Are you under the influence of alcohol or drugs, prescribed or otherwise?
Do you have any adverse reactions to pigments, dyes, disinfectants, or soap? (Medicines or Topical Solutions)

Doctor’s Information

Doctors Address
Doctors Address
City
State/Province
Zip/Postal

Waiver and Release

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#2
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I have been provided with information describing the tattoo and / or piercing procedure to be performed and instructions on aftercare. I have been made aware that if I have any signs or symptoms of infection, such as swelling, pain, redness, fever, unusual discharge or odor to contact my physician. It is also my responsibility to take care of my new tattoo and / or piercing site according to the instructions provided both verbally and in writing.

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