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Consent Form

Medical Questionnaire

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Please read the below Terms & Conditions in full:

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo and that all of my questions have been answered to full satisfaction. I specifically acknowledge I have been advised of the facts and the matters set forth below and agree to the following: 

- If I have any condition that might affect the healing of this tattoo, I will advise my tattooist. I am not pregnant or nursing. I am not under the influence of alchohol or drugs

- I do not have medical or skin conditions such as but not limited to; acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooist.

- I acknowledge it is not reasonably possible for my tattooist to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.

- I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch up work needed, due to my own negligence, will be completed at my own expense.

- I realise that variations in colour and design may exist between any tattoo selected by me and as ultimately applied on my body. I understand that if my skin colour is dark, the colours will not appear as bright as they do on light skin.

- I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo.

- I acknowledge that a tattoo is a permenent change to my appearence and that no representations have been made to me as to the ability to change or remove my tattoo. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo.

- I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooist that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct by my tattooist reasonably necessary to perform the tattoo procedure.

Please note, medical advice should be sought in any case of doubt as to whether the procedure is suitable. If any question is answered ‘Yes’ the procedure will need to be reviewed by your tattoo artist and medical advice may need to be obtained where applicable.

Questions: (Please answer 'Yes' or 'No' only)

Suffers from any heart conditions? (eg prosthetic heart valve / heart valve disease / angina / blood pressure)
Suffers from epilepsy? (If "Yes" how controlled)
Suffers from haemorphilia / other clotting disorders? ​
Suffers from any known blood borne virus? (eg. Hep B / Hep C / Hep D / HIV)
Suffers from diabetes or lupus? ​
Suffers from any problems with skin healing in the past? (eg. psoriasis / eczema)
Suffers from any "lumpy" raised scars? (eg. Keloid scars)
Suffers from any known allergic responses? (eg. plasters/creams/metals/iodine/shellfish/latex/food stuffs/other)
Takes any prescribed medication regularly (especially any anticoagulants such as Warfarin or high dose aspirin; any immuno- suppressants such as steroids)
Is the client pregnant? ​
Any known / previous reaction to dye pigments? ​
Prone to "fainting attacks"? (If "Yes" state reason below)

If you have answered 'Yes' to any Medical Questionnaire questions, please discuss this with your tattoo artist before submitting below.

 

By signing and submitting below you acknowledge reading the above Terms & Conditions in full, filling in the above consent form and medical questionnaire to the best of your knowledge and are above the legal age of 18 to be tattooed. Please note, you may be asked to show age identification if you look under the age of 25.

If you have been asked by your artist for proof of age identification, please take a picture and upload it here. Ensure it is shown to the artist before hitting submit below.

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