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Dreadmoor Tattoo

Consent & Waiver Form

Birthday
Month
Day
Year
Valid Government - Issued ID?
Yes
No

Current Address

Address

Risk Notification


Please Read Carefully and Acknowledge each item

I understand that body art procedures can cause allergic reactions, bleeding, bruising, pain, swelling, and irreversible modifications to the body.
I acknowledge
I understand that body art procedures increase the risk of infection.
I Acknowledge
I understand that individuals with heart conditions are at greater risk of bacterial endocarditis and should consult a physician before proceeding.
I acknowledge

Client Health Evaluation

Please answer the following questions below.

Are you 18 years of age or older?
Yes
No
Have you eaten within the past four hours?
Yes
No
Are you under the influence of drugs or alcohol?
Yes
No
Have you taken blood thinners, NSAIDS, or any medications that may affect healing?
Yes
No
Do you have allergies to dyes, pigments, latex, iodine, or similar products?
Yes
No
Do you have Hemophilia, Seizures, narcolepsy, or other conditions affecting procedures?
Yes
No
Do you have any skin diseases, sensitivities, or reactions to soaps/disinfectants?
Yes
No
Do you have any communicable diseases ( Hepatitis, HIV, etc.)?
Yes
No
Do you have diabetes, high blood pressure, heart disease, or any healing impairments?
Yes
No
Are you or have you been pregnant within the last 3 months?
Yes
No
If you have medical concerns have you consulted your physician before receiving body art?
Yes
No

Informed Consent Statement

By signing below, I confirm: 


  • I am voluntarily obtaining this tattoo or piercing procedure of my own free will. 

  • I have read and understand the risks and health screening questions above.

  • I have had the opportunity to ask questions before, during, and after the procedure. 

  • I have recieved both written and verbal aftercare instructions.

  • I understand that the artist will maintain a record of this procedure.

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