Tattoo Consent Form

Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.

First Name

Select an Address

Todays Date

Birthday

Important information for tattoo clients
Known (potential) risks associated with tattooing.

Last Name

Initials

Phone

Area getting tattooed

Tattoo Artist

- Scarring
- Blood Poisoning
- Bleeding
- Localised Infection
- Allergic Reactions to pigment
- Localised swelling around site areas

Individual Client Consent

I declare that I give my full consent to the tattooing being carried out by the aforementioned practitioner.

I confirm that potential complications (shown above) from the procedure undertaken and aftercare

instructions have been explained to me and I have been given the chance to ask any questions I may

have. A written aftercare advice sheet containing more detailed information has also been given to me

and I understand and agree that it is my responsibility to read this and follow any instructions given

until the tattoo is fully healed.

I confirm that the above information provided by me for this consent form

is correct to the best of my knowledge, that I am over the age of consent for this procedure (18) and

that I am not currently under the influence of alcohol or drugs.

Please select yes in the drop down menus if you have experienced any of the following:

Skin disorders

Immune system disorders

Seizures, epilepsy or fainting

Bulimia

Pregnancy or breast feeding

Consumed alcohol / drugs in the past 24 hrs

Heart conditions

Blood disorders

Known allergies

Psychiatric disorders

Currently on blood thinning medication

Any conditions not mentioned you feel may be relevant?

If you responded "yes" to any of the above medical questions, please provide further information below.

I confirm that the information given in this form is true

Data Protection

All data given is safeguarded and protected under GDPR guidelines. Your data is stored securely on our computer system and is not shared with any third-party companies. The purpose of this information is to prove client identity; however, we may use it to contact you as part of our aftercare process. We may also contact you regarding promotional offers, discounts and giveaways.

I agree to the terms & conditions

Your Signature

Thanks for submitting!