Tattoo Consent Form

Your Information

First Name *

Last Name *

Email Address *

Phone Number *

Birthday *

Street Address *

City

State/Province

ZIP / Postal code

Country

Pre Procedure Questions

Are you currently under the influence of drugs or alchohol? *YesNo

Are you pregnant or nursing? *YesNo

Do you have a communicable disease? *YesNo

Do you have any skin conditions? If yes, please list. *(e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)

Please include your medical history? *(e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)

Acknowledgment and Waiver

I understand that this procedure is a permanent change to my skin and body.

I allow my tattoo and body to be photographed and be used in portfolios, social media and any other media deemed desirable by the tattooist to be showcased.

I acknowledge that Jon Osiris (DBA The Sacred Serpent LLC) does not offer refunds.

I acknowledge that the studio/artist does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo and have NOT applied any topical lidocane creams or pain relievers on my skin prior to coming in for my appointment

I understand that I need to take care of the tattoo by following the instructions given to me by the tattooist

I understand that I could get an infection or worse if I don’t follow the instructions given to me in regards of taking proper care of my tattoo.

I indemnify and hold harmless Jon Osiris (DBA The Sacred Serpent LLC) and Tattoo Vinyasa against any claims, expenses, damages, and liabilities.

I confirm that the information I provided in this document is accurate and true.

Consent

Full Legal Name *

Your Information

Pre Procedure Questions

Acknowledgment and Waiver

Consent

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