Tattoo Consent Form Template

Studio Name: [Studio Name]
Studio Address: [Address]
Phone/Email: [Contact]
Artist Name (Optional): [Artist]
Appointment Date: [Date]

1. Client Information

1.1 Full Legal Name: [Client Name]
1.2 Date of Birth: [DOB]
1.3 Age: [__] (must meet legal minimum age)
1.4 Address: [Address]
1.5 Phone/Email: [Contact]

2. Government ID Verification

2.1 ID Type: ☐ Driver license ☐ State ID ☐ Passport ☐ Other: []
2.2 Issuing State/Country: []
2.3 ID Number (Last 4 Only) (Optional): [____]
2.4 ID Expiration (Optional): [Date]
2.5 ID Verified By (Staff): [Name/Initials]

3. Tattoo Details

3.1 Design/Description: [Brief description]
3.2 Placement on Body: [Location]
3.3 Approx. Size: []
3.4 Colors/Ink Notes (Optional): []
3.5 Stencils/References Provided By: ☐ Client ☐ Studio ☐ Both

4. Health and Safety Disclosures

4.1 I certify the following (check all that apply):
☐ I do not have any condition that would make tattooing unsafe for me
☐ I have disclosed all relevant medical conditions below
☐ I am not under the influence of alcohol or drugs
☐ I have eaten within the last [__] hours (recommended)
☐ I understand tattoos involve skin puncture and may cause pain, swelling, redness, scarring, allergic reaction, or infection

4.2 Disclose any of the following (check and explain):
☐ bleeding disorder or use of blood thinners: [Explain]
☐ diabetes: [Explain]
☐ heart condition: [Explain]
☐ immune disorder/autoimmune condition: [Explain]
☐ history of keloids/scarring: [Explain]
☐ skin condition at area (eczema/psoriasis/dermatitis): [Explain]
☐ allergies (latex/ink/adhesives): [Explain]
☐ seizure condition: [Explain]
☐ recent surgery/medical procedure: [Explain]
☐ other: [Explain]

4.3 Pregnancy/Nursing (Optional per local rules):
☐ Not pregnant/not nursing ☐ Pregnant ☐ Nursing (studio policy: [Policy]).

5. Consent and Acknowledgments

5.1 I consent to receiving a tattoo from [Studio Name] and understand the procedure and risks.
5.2 I understand results may vary based on skin type, placement, healing, and aftercare.
5.3 I agree to follow the aftercare instructions provided and understand poor aftercare can cause infection or affect appearance.
5.4 I understand touch-up policy (if any): [Policy] and fees may apply: ☐ Yes ☐ No.

6. Aftercare Acknowledgment

6.1 I received aftercare instructions: ☐ written ☐ verbal ☐ both.
6.2 I understand I should seek medical care if I have signs of infection or unusual reactions.

7. Photo/Video Release (Optional)

7.1 Studio may photograph/film the tattoo for portfolio/marketing: ☐ Yes ☐ No.
7.2 If yes, permitted channels: ☐ website ☐ social media ☐ print ☐ other: [__].

8. Payments and Deposits (Optional)

8.1 Deposit received: ☐ Yes ☐ No. Amount: $[].
8.2 Pricing estimate (optional): $[]. Final price may vary based on time and complexity.

9. Release of Liability (To the Extent Permitted)

9.1 I release [Studio Name] and its artists from claims arising from the tattoo procedure, except to the extent caused by gross negligence or willful misconduct, where such limits are not prohibited by law.

Signatures

Client: [Full Name]
Date: [Date]
Signature: ___________________________

Artist/Studio Representative: [Name]
Date: [Date]
Signature: ___________________________

Witnesses (If Required)

Witness Name: [Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization (Optional)

State of [State]
County of [County]

On [Date], before me, [Notary Name], personally appeared [Client Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this form, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________