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Tattoo & Piercing Procedure -Form Fill

Section One
Q1

Name

First Name
Q2

Name

Last Name
Q3

Email
Q4

Phone Number
Q5

The date of my appointment is

Date
Q6

I understand that this is a binding contract with Tattoo Studio & I have been given full opportunity to ask any and all questions about my procedure. All of my questions have been answered to my satisfaction. I understand that my procedure may be permanent, and may require surgical procedure for removal. I am aware that removal may cause scarring.
Q7

I do not have any medical conditions or communicable diseases (including but not limited to diabetes, epilepsy, hemophilia, hepatitis, HIV, AIDS, tuberculosis, COVID19). I do not have a skin condition that may interfere with the proper healing of my procedure (including but not limited to acne, scarring or keloids, eczema, psoriasis, freckles, moles, or sunburn). I am not pregnant or nursing. I have informed the agent of Tattoo Studio and documented below of any exceptions to the above. I am not under the influence of drugs, alcohol, or any narcotic, including but not limited to prescription pharmaceuticals, & over the counter medications. I am aware that being under the influence can have an adverse effect on the procedure. I agree that Tattoo Studio cannot determine if I will have an allergic reaction to any of the products used to complete my procedure. I attest that I have no known allergies, or if I do I have documented them on the back of this form and alerted the agent of Tattoo Studio.
Q8

I am aware of the possibility of infection with my procedure. I understand that when I leave the premises of Tattoo Studio, my procedure is only half complete. It is my responsibility to follow the aftercare procedures recommended by Tattoo Studio. Tattoo Studio makes no claim to the success or validity of the recommended aftercare procedures, they are simply guidelines. I agree to not hold Tattoo Studio liable for any necessary touch-up work cause by my own negligence. I understand that skin color will have an effect on the final result of my tattoo. I agree to leave the premises of Tattoo Studio or any other location where Tattoo Studio is engaged in business promptly upon request, for any reason whatsoever, by any employee or agent of Tattoo Studio.
Q9

Today's Date

Date
Q10

Signature