Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Today's Date *

MM

DD

YYYY

FEMALE ONLY: Pregnancy or Nursing? *

Yes

No

N/A

Do you have a communicable disease? *

Yes

No

Do you have any skin conditions? *

Yes

No

Are you currently taking any medication? *

Yes

No

Any known allergies? *

Yes

No

Please check the boxes below to confirm you have read and fully understand the following:

*

I understand that this procedure is a permanent change to my skin and body

*

I allow my tattoo to be photograped and used for online and portfolio use.

*

I acknowledge that the tattoo shop does not offer refunds.

*

I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.

*

I understand that I need to take care of my tattoo by following the instructions given to me by the artist

*

NO GYM/WORKING OUT FOR 7 DAYS. You agree not to exercise.

*

Aftercare is vital and it is MY responsibility to look after the tattoo to achieve the best healing

*

I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo.

*

I indemnify and hold harmless the tattoo shop against any claims, expenses, damages, and liabilities.

*

I confirm that the information I provided in this document is accurate and true.