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Practitioner
Lauren Smith
Appointment Date
Day
Month
Year
Birthday
Day
Month
Year
Form of ID used
Driving License
Passport
Other
Do you have any blood borne pathogens, transmittable diseases or recent illnesses? (It’s ok if you do, we ask to ensure ours and others’ safety).
Yes
No
Have you seen the design/s being tattooed & agree to having it/them tattooed on your body?
Yes
No
Are you fully informed of the inherent risks associated with getting a tattoo; known & unknown, including but not limited to, infection, scarring, difficulties in detecting melanoma & allergic reactions and still wish to proceed with the tattoo?
Yes
No
Do you agree to follow the advice the artist gives you regarding healing the tattoo and that any touch up work required as a result of your own negligence will be completed at your own expense?
Yes
No
Are you currently under the influence of drugs or alcohol?
Yes
No
Are you currently pregnant or breastfeeding?
Yes
No
Medical conditions or medication
Do you have any other conditions that may interfere with the application or healing of the tattoo?
Yes
No
Do you agree the artist is not responsible for the meaning or spelling of any symbols or text included within the tattoo design?
Yes
No
Do you know and understand that a tattoo is a permanent change to your appearance and can only be removed by laser or surgical means, which can be disfiguring and does not guarantee skin restoration?
Yes
No
Do you acknowledge and understand that this is a legal contract and agree to reimburse the artist for any legal fees and costs incurred in any legal action you may bring against the artist?
Yes
No

I declare that I give my full consent to the tattooing being carried out by the aforementioned practitioner. I understand that this procedure is a permanent change to my skin and body. I confirm that I understand all potential complications, (eg. infection, swelling) for the procedure undertaken and am willing to go ahead with the procedure at my own risk and my practitioner accepts no liability. I agree that it is my responsibility to look after my tattoo following the guidelines given to me, until the site has healed.

I confirm that the above information provided by me for this consent form is correct to the best of my knowledge, that I am over the age of 18 and that I am not currently under the influence of alcohol or drugs.

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