Name *

First Name

Last Name

Phone *

(###)

###

####

Health Information *

Please check any that apply:

Pregnant or Nursing

Bleeding disorders

Diabetes

Heart condition or pacemaker

Allergies

Skin conditions

Bloodborne diseases

Currently on antibiotics or blood thinners

Prone to fainting or seizures

Other conditions

CONSENT AND ACKNOWLEDGMENT *

I am 18 years of age or older and have provided valid photo ID

I understand tattooing involves risks such as infection or allergic reaction.

I do not have any condition that may affect healing.

I’ve been informed of risks including scarring and complications.

I agree to follow aftercare instructions provided by the artist.

I understand results vary and no guarantees have been made.

I release the artist and studio from all liability and damages.

I allow use of tattoo photos for portfolio/promotional use.