Client consent & release

Please fill this out before your appointment. It takes about 5 minutes.

Bring your ID to the appointment. You must be 18 or older and bring a valid, unexpired government-issued photo ID (driver's license, state ID or passport). Your artist will check it in person before starting. Do not upload your ID here. We never collect copies online.

About you Full legal name (as on your ID)

Preferred name

Pronouns

Date of birth

Phone

Email Address

Emergency contact name

Emergency contact phone

Appointment

Artist

Appointment date

Tattoo description Placement on body

Health questions

Your answers are private and only seen by studio staff. They help us keep you safe. A "yes" doesn't automatically mean we can't tattoo you, but we may ask for a doctor's note.

Are you pregnant or nursing?

yes no

Do you have diabetes?

yes no

Heart condition, pacemaker or high blood pressure?

yes no

Hemophilia or another bleeding disorder?

yes no

Taking blood thinners (including daily aspirin)?

yes no

Epilepsy, seizures or fainting spells?

yes no

A weakened immune system, or a bloodborne condition we should know about?

yes no

Skin condition (eczema, psoriasis, keloids) or moles near the area?

yes no

Allergies to latex, inks/pigments, ointments or numbing products?

yes no

Alcohol or recreational drugs in the last 24 hours?

yes no

Accutane / isotretinoin in the last 6 months?

yes no

Current medications If you answered yes to anything above, tell us more

Please read & tick each one I am 18 or older and will bring a valid government-issued photo ID to my appointment. I will not be under the influence of alcohol or drugs at my appointment. I understand a tattoo is permanent, and removal or changes may be costly, painful and not fully possible. I will review and approve the final design, spelling and placement before the tattoo begins. I understand the risks, including infection, allergic reaction and scarring, and that results and colors vary with skin type and healing. I will follow the aftercare instructions I'm given. Healing problems from not following them are my responsibility. The information I've given is true and complete to the best of my knowledge. I understand deposits are non-refundable. [TODO: studio's reschedule policy] Optional: Tethered may photograph my tattoo for its portfolio and social media.

Signature Type your full legal name Sign below

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