Tattoo, as the famous body art, also gets protection in the form of tattoo waivers.

ATAK BODY ART CONSENT FORM

CLIENT INFO

Please fill your name: *

Please enter your full name.

Phone Number: * Please enter your phone number.

Email: * Please enter your email.

Date of Birth: *

Please enter valid date.

Gender

Male

Female

Way past those hang ups

Please select at least one choice above.

Emergency contact: * Please enter your name.

Emergency contact's Phone: * Please enter your phone number.

MEDICAL HISTORY

Other medical conditions? * Please enter your answer here.

How long has it been since you last ate? * Please enter your answer here.

Is there any information you feel you should provide to the body art practitioner? * Please enter your answer here.

INFORMED CONSENT TO RECEIVE BODY ART

PLEASE READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING

I, as the name listed above, confirm the following by initialing each applicable item:

NOTICE*: Tattoo inks, dyes, and pigments that have not been approved by the federal Food and Drug Administration have health consequences that are unknown.

I am the person on the legal ID presented as proof that I am at least 18 years of age. * Please check it here.

I am not under the influence of alcohol or drugs and that I am voluntarily submitting myself to receive body art without duress or coercion. I understand the permanent nature of receiving body art and that removal can be expensive and may leave scars on the procedure site. I acknowledge that the information that I have provided in the medical questionnaire is complete and true to the best of my knowledge. * Please check it here.

I acknowledge that the information that I have provided in the medical questionnaire is complete and true to the best of my knowledge. * Please check it here.

I understand the permanent nature of receiving body art and that removal can be expensive and may leave scars on the procedure site. * Please check it here.

All questions about the body art procedure have been answered to my satisfaction, and I have been given written aftercare instructions for the procedure I am about to receive. * Please check it here.

I understand the restrictions on physical activities such as bathing, recreational water activities, gardening, contact with animals, and the durations of the restrictions. * Please check it here.

I understand that any medical information obtained will be subject to the federal Health Insurance Portability and Accountability Act of 1996 (HIPPA). * Please check it here.

*I am aware that tattoo inks, dyes, and pigments used on the procedure site have not been approved by the federal Food and Drug Administration, and that the health consequences of using these products are unknown. * Please check it here.

I am aware of the signs and symptoms of infection, including, but not limited to redness, swelling, tenderness of the procedure site, red streaks going from the procedure site towards the heart, elevated body temperature, or purulent drainage from the procedure site. * Please check it here.

I understand there is a possibility of getting an infection as a result of receiving body art particularly in the event that I do not take proper care of the procedure site. * Please check it here.

I will seek professional medical attention if signs and symptoms of infection occur. * Please check it here.

I agree to follow all instructions concerning the care of my tattoo, and that any touch-ups needed due to my own negligence will be done at my own expense. * Please check it here.

I understand that there is a chance I might feel lightheaded, dizzy during or after being tattooed. * Please check it here.

I agree to immediately notify the artist in the event I feel lightheaded, dizzy and/or faint before, during or after the procedure. * Please check it here.

I,as the name listed above, have been fully informed of the risks of body art including but not limited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and antibiotics. Having been informed of the potential risks associated with a body art procedure, I still wish to proceed with the body art application and I assume any and all risks that may arise from body art.

Description of Procedure * Please enter your answer here.

Procedure Site: * Please enter your answer here.

Signature of Client: *

Click to sign

Please sign here.

Date *

Please enter valid date.

TATTOOER INFO BELOW

Tattooer: * Please enter your name.

Signature of Tattooer: *

Click to sign

Please sign here.

Needle * Please enter your answer here.

Tube * Please enter your answer here.