Tattoo Consent Form | OLD CITY TATTOOS

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Home
About us
Artists
Care and Information
Booking

Old city tattoos

tattoo Consent Form

TODAY'S DATE*

TATTOO ARTIST*

Moises

Lisa

Jadda

Camila

Gabriel

Giovanni

VALID ID SHOWN TO ARTIST*

Yes

No

I HAVE ASKED TO HAVE A PERMANENT TATTOO THAT I UNDERSTAND WILL MARK ME IN A PERMANENT WAY. I AM FULLY AWARE THAT IT MAY NEVER BE REMOVED IF I CHANGE MY MIND ABOUT IT.*

Yes

No

I AM NOT UNDER THE INFLUENCE OF ALCOHOL OR DRUGS.*

Yes

No

I AM RESPONSIBLE FOR CONFIRMING THE SPELLING OF MY TATTOO IS CORRECT BEFORE IT IS TATTOOED AND RESPONSIBLE FOR FINDING OUT THE MEANINGS OF SYMBOLS.*

Yes

No

I AM AWARE THAT THE COLOURS OF MY TATTOO MAY FADE OVER TIME AND I WILL USE FACTOR 50 SUNCREAM WHEN NEEDED TO HELP PREVENT THIS WHEN EXPOSED TO THE SUN.*

Yes

No

I CONSENT TO ANY PICTURES TAKEN TO BE USED BY THE ARTIST FOR SOCIAL MEDIA AND ADVERTISING PURPOSES.*

Yes

No

ARE YOU PREGNANT OR BREASTFEEDING?*

Yes

No

ARE YOU PRONE TO FAINTING OR PANIC ATTACKS?*

Yes

No

DO YOU SUFFER FROM ANY HEART CONDITIONS SUCH AS PROSTHETIC HEART VALVE, HEART VALVE DISEASE, ANGINA OR BLOOD PRESSURE PROBLEMS?*

Yes

No

DO YOU SUFFER FROM EPILEPSY?*

Yes

No

IF YES, HOW CONTROLLED?

DETAILS

DO YOU SUFFER FROM HAEMOPHILIA OR OTHER CLOTTING DISORDERS?*

Yes

No

DO YOU SUFFER FROM ANY KNOWN BLOODBORNE VIRUS SUCH AS HEP B, HEP C, HEP D OR HIV?*

Yes

No

DO YOU SUFFER FROM DIABETES OR LUPUS?*

Yes

No

DO YOU SUFFER FROM ANY PROBLEMS WITH SKIN HEALING IN THE PAST, SUCH AS PSORIASIS OR ECZEMA?*

Yes

No

DO YOU SUFFER FROM ANY LUMPY OR RAISED SCARS, ALSO KNOWN AS KELOID SCARS?*

Yes

No

DO YOU SUFFER FROM ANY KNOWN ALLERGIC RESPONSES SUCH AS PLASTERS, CREAMS, METALS, IODINE, SHELLFISH, LATEX, FOODSTUFFS OR OTHER ALLERGIES?*

Yes

No

IF YES, PLEASE INDICATE WHICH

DETAILS

DO YOU TAKE ANY PRESCRIBED MEDICATION REGULARLY, ESPECIALLY ANTICOAGULANTS SUCH AS WARFARIN OR HIGH DOSE ASPIRIN, OR IMMUNOSUPPRESSANTS SUCH AS STEROIDS?*

Yes

No

IF YES, PLEASE LIST WHICH

ANY OTHER INFORMATION YOU THINK WE SHOULD KNOW?

Your tattoo aftercare instructions will be provided as a PDF on the confirmation page after you submit this form. I understand that it is my responsibility to download and read the aftercare instructions provided by Old City Tattoos and to follow them carefully throughout the healing process. I understand that following the aftercare instructions is important to help minimise the risk of infection, irritation, scarring and other complications during the healing process.

I CONFIRM THAT I WILL DOWNLOAD, READ AND FOLLOW THE AFTERCARE INSTRUCTIONS PROVIDED BY OLD CITY TATTOOS.*

I agree

LEGAL NAME*

ADDRESS

POSTCODE

DATE OF BIRTH*

AGE

PHONE NUMBER*

EMAIL*

SIGNATURE*

EMERGENCY CONTACT - If something happens, your emergency contact might need to explain your medical history, allergies or medications.

NAME

PHONE NUMBER

I confirm that all information I have provided in this form is true and accurate to the best of my knowledge. I confirm that I have read and understood the information provided, including the risks associated with tattooing and the aftercare advice, and that I have had the opportunity to ask any questions before proceeding. I give my full and informed consent to the tattoo being carried out by the named artist. I understand that it is my responsibility to download, read and follow the aftercare instructions provided by Old City Tattoos.

I CONFIRM THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE DECLARATION.*

I agree

____________________

STUDIO USE ONLY

To be completed by the tattoo artist only.

INK BRANDS

INK COLOURS

BATCH / LOT NUMBERS

ARTIST NAME

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