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Tattoo Consent Form

First name*

Last name*

Birthday*

Day

Month

Year

Email*

Phone*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Valid Photo ID Checked

ID Type

Procedure Details

Body Area*

Apprentice/model Status

Who will carry out the procedure?*

Qualified practitioner

Student / apprentice practitioner

If acting as a model, please confirm:*

I understand this procedure may be carried out by a student or apprentice

I understand this procedure will be fully supervised

I understand the procedure may take longer than usual

I understand I can stop the procedure at any time

Model / discounted rate applied?*

Yes

No

Medical Declaration

Please select Yes or No for each question:

Heart condition or heart murmur*

Yes

No

Blood-borne viruses (e.g. Hepatitis, B/C, HIV,)*

Yes

No

Bleeding or clotting disorders*

Yes

No

Epilepsy, seizures or fainting episodes*

Yes

No

Diabetes*

Yes

No

Autoimmune or immune-surppressive conditions*

Yes

No

Skin conditions (eczema, psoriasis, keloid scarring)*

Yes

No

Allergies (metals, latex, inks, antiseptics)*

Yes

No

Asthma*

Yes

No

Any infectious or contagious illness*

Yes

No

Are you pregnant or breastfeeding?*

Yes

No

Are you taking any medication (including blood thinners or steroids)?*

Yes

No

Alcohol & Drug Declaration

Please confirm:

I confirm I am not under the influence of alcohol or non-prescribed drugs

I understand the procedure will not proceed if impairment is suspected

Informed Consent

Please tick to confirm:

I confirm the information I have provided is accurate and complete

I understand tattooing and body piercing carry risks including infection, allergic reaction, scarring and delayed healing

I understand healing times and results vary between individuals

I have had the opportunity to ask questions

I agree to follow all aftercare instructions provided

I accept responsibility for complications caused by failure to follow aftercare advice

Consent to photography for records / portfolio / training purposes*

Yes

No

Data Protection & GDPR

I consent to my personal and medical data being stored and processed in accordance with UK GDPR for client safety, legal compliance and record keeping

Digital Signature

Client Full Name*

Signature*

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date*

Day

Month

Year

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