Birthday

Tattoo Date

Artist Name*

I am over the age of 18 and have truthfully represented my age.*

I have eaten within the last two hours.*

Have you consumed alcohol or drugs within the last 24 hours?

Is your blood pressure regular?*

Do you have a heart condition?*

D you have any conditions that compromise your immune system?*

Have you ever suffered from HIV, Hepatitis A,B or C or any blood disorder?*

Are you allergic to the penicillin family of drugs?*

Are you diabetic?*

Do you have any blood clotting disorders?*

Are you pregnant or breast feeding?*

Do you suffer with any seizure causing condition?*

Are you prone to dizziness or fainting?*

I agree that every care has been taken to ensure that this procedure has been carried out in a hygienic manner and that the aftercare of the tattoo is my sole responsibility*

I agree that I understand that reaction to the pigments or products is still possible, even after the tattoo has healed, I accept that this is a risk that my artist cannot be held liable for.*

I agree to follow the aftercare from my artist*

I acknowledge and agree to the fact that infections are a real and common risk when getting tattooed, particularly in the event I do not take proper and adequate care of my new tattoo. *

I agree that upon leaving the studio I take full responsibility for the health and healing of my tattoo and liability for any infections are on myself and not my artist.*

By completing this consultation form I give my full permission for my tattoo to go ahead and I agree that I have provided all information truthfully.*