electronic waiver for tattoo - WaiverElectronic

First and Last Name: * Please enter your name.

Please Enter Date *

Please enter valid date.

Please fill in Address: *

Please enter address.

Phone number: * Please enter your phone number.

Email: * Please enter your email.

Describe the tattoo to be lightening/removed. * Please enter your answer here.

In which area of the body or face is the tattoo located? * Please enter your answer here.

If you are currently under the care of a medical professional or taking any prescription medication, please explain. * Please enter your answer here.

Initial Here

The nature and method of the proposed pigment (tattoo) lightening procedure has been explained to me including risks or possibility of complications during &/or following its performance. * Please click the yellow area and provide your initials here.

Initial Here

I understand there may be a certain amount of discomfort or pain associated with the procedure and that the other adverse side effects may include: minor and temporary bleeding, bruising, redness or other discoloration and swelling. Fever blisters may occur on the lips following lip procedures in individuals prone to this problem. Secondary infection in the area of the procedure may occur, however if properly cared for, this is incredibly rare. * Please click the yellow area and provide your initials here.

Initial Here

I understand that multiple treatments may be required in order to attempt to achieve my desired results. However, I have not received any guarantees to the quality of the out of the process. * Please click the yellow area and provide your initials here.

Initial Here

I understand there are medical options available for pigment (tattoo) removal. I have decided to decline those methods. * Please click the yellow area and provide your initials here.

Initial Here

I understand that the unwanted pigment may not be successfully lightened to the point that it can no longer be seen. Scarring as hyper-pigmentation or hypo-pigmentation, or other damage to the skin may occur during this process and may be permanent. I will not hold my technician, and/or the distributor of tattoo removal products used in this attempted pigment (tattoo) lightening or removal liable for any damages that may occur to my person. * Please click the yellow area and provide your initials here.

Which of the following best describes your skin type? (Please choose one) *

Always burns, never tans.

Always burns, sometimes tans.

Sometimes burns, always tans.

Rarely burns, always tans.

Brown, moderately pigmented skin.

Black skin.

Please select at least one choice above.

Initial Here

FOR SKIN TYPES V & VI ONLY: I understand that I am at a higher risk for hyper-pigmentation and hypo-pigmentation than other skin types. I agree to the risk involved. Please click the yellow area and provide your initials here.

Initial Here

I understand that lightening tattoo pigment is difficult, if even possible, regardless of method (solution, laser or other medical form of removal). As a result, I will not hold my technician or this establishment responsible for any resultant failure to lighten the unwanted pigment. * Please click the yellow area and provide your initials here.

Initial Here

I agree to submit to before and after photographs, and give my permission to use such photographs for publication and/or teaching purposes. * Please click the yellow area and provide your initials here.

Initial Here

I agree to follow all aftercare instructions provided by me by ArchAmbition LLC. * Please click the yellow area and provide your initials here.

Initial Here

I have been duly informed of the natures, risks, possible complications and consequences as listed above. I further understand that my technician is not a medical doctor. * Please click the yellow area and provide your initials here.

Initial Here

I understand all information listed above, have had my questions answered, and agree to all conditions and provisions of this document as evidenced by signature below. I accept the risks for having this procedure done. * Please click the yellow area and provide your initials here.

Initial Here

I understand that there is a fee for this service and additional fee for all additional sessions. The fees have been explained to me and I agree to the fees. * Please click the yellow area and provide your initials here.

Initial Here

I understand fees for the additional session(s) cannot be determined until the results from this first session are completed and analyzed. Fees for additional session(s) are reliant upon the extent of work per additional session(s). * Please click the yellow area and provide your initials here.

Initial Here

I have disclosed all that has been asked of me to the best of my ability and I understand all information listed above. I have had all my questions answered and agree to all conditions and provisions of this document as evidenced by signature below. I accept the risks for having this procedure done therefore release my technician and ArchAmbition LLC from any and all liability. * Please click the yellow area and provide your initials here.

Signature of Client: Signature applies to consent to process during agreed treatment plan period. *

Click to sign

Please sign here.

Electronic waivers for tattoos help you achieve the business desired purpose.

Permanent Cosmetic & Body Tattoo Removal/Lightening Client Consent

Electronic waivers for tattoos help you achieve the business desired purpose.

Permanent Cosmetic & Body Tattoo Removal/Lightening Client Consent

​