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Tattoo Consent Form

This document is a tattoo consent form for Chateau Tattoo in Salmo, BC. It collects client information such as name, date of birth, address, and contact details. It acknowledges that the client understands the tattoo process, risks of infection, allergic reactions, and aftercare responsibilities. It confirms the client does not have any medical conditions, diseases, or impairments that would interfere with getting a tattoo. The client consents to the tattoo and will not hold the tattoo parlor responsible. The form asks health questions and requires the client's signature to provide consent.

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364 views2 pages

Tattoo Consent Form

This document is a tattoo consent form for Chateau Tattoo in Salmo, BC. It collects client information such as name, date of birth, address, and contact details. It acknowledges that the client understands the tattoo process, risks of infection, allergic reactions, and aftercare responsibilities. It confirms the client does not have any medical conditions, diseases, or impairments that would interfere with getting a tattoo. The client consents to the tattoo and will not hold the tattoo parlor responsible. The form asks health questions and requires the client's signature to provide consent.

Uploaded by

lydia.gentry.dvm
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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TATTOO CONSENT FORM

Chateau Tattoo
1443 Airport Road
Salmo BC V0G1Z0
(250)551-8687

Client Information:
● Name:
● Today’s Date:
● Date of Birth:
● Address:
● City:
● Postal Code:
● Province:
● License/Health Card # (if applicable):
● Phone:
● Email:
Agreement and Acknowledgment:
I acknowledge by signing this agreement that I have been given the full
opportunity to ask any questions I might have about obtaining a tattoo, and all of
my questions have been answered to my full satisfaction.
I specifically acknowledge the following:
● Medical Conditions: If I have any condition that might affect
the healing of this tattoo, I will advise my tattooer. I confirm that I am not
pregnant or nursing and not under the influence of alcohol or drugs.
● Skin Conditions and Diseases: I do not have medical or skin
conditions, diseases, or infections that might interfere with the tattoo
process. I do not have any communicable diseases or infections, and if I
do, I will inform my tattooer.
● Responsibility: I will not hold Chateau Tattoo responsible for
the work performed. I confirm that I have seen the artwork and/or stencil
placed on my body and verified its accuracy.
● Physical, Mental, or Medical Impairments: I do not have any
impairment or disability that might affect my well-being as a result of
getting a tattoo. I understand the permanency of tattoos.
● Allergic Reactions: I accept the risk of potential allergic
reactions to pigments or processes used in my tattoo.
● Infection and Aftercare: I acknowledge the risk of infection
due to improper care. I will follow provided aftercare instructions and will
be responsible for any touch-up work due to negligence.
● Age Confirmation: I confirm that I am of legal age (18) to
receive a tattoo.
Consent:
I consent to the application of the tattoo and to any actions or conduct of the
representatives and employees of Chateau Tattoo reasonably necessary to
perform the tattoo procedure.
Health Questions:
● Do you have HIV, AIDS, Hepatitis, or any other blood-borne
illness? Yes / No
● Do you have any other medical conditions or allergies? If yes,
please specify: ______________
● Occupation: __________________
● Is this your first tattoo? Yes / No
● Are you afraid of needles? Yes / No
● Have you eaten in the past 2 hours? Yes / No
● Have you ever fainted? Yes / No
● Are you currently using any medications or drugs? Yes / No
● How did you hear about Chateau Tattoo?
● Do you have any questions about the above information?

Sign___________________________
Print name _____________________
Date ___________________________

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