West One Tattoo
CONSENT TO TATTOO PROCEDURE
NAME:
ADDRESS:
DATE OF BIRTH:
I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all
questions which I might have about the obtaining of a tattoo and that all of my questions have been
answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and
matters set forth below and I agree as follows:
If I have any condition that might affect the healing of this tattoo, I will advise my tattooer. I am
not pregnant or nursing. I am not under the influence of alcohol or drugs.
I do not have medical or skin conditions such as but not limited to: acne, scarring (keloid) eczema,
psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo.
If I have any type of infection or rash anywhere on my body, I will advise my tattooer.
I acknowledge it is not reasonably possible for the representatives and employees of this tattoo
shop to determine whether I might have an allergic reaction to the pigments or processes used in
my tattoo, and I agree to accept the risk that such a reaction is possible.
I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly
in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I
agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my
own negligence, will be done at my own expense.
I realize that variations in color and design may exist between any tattoo as selected by me and as
ultimately applied to my body. I understand that if my skin color is dark, the colors will not
appear as bright as they do on light skin.
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin
altering procedures, it may result in adverse changes to my tattoo.
I acknowledge that a tattoo is a permanent change to my appearance and that no representations
have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I
do not have a physical, mental or medical impairment or disability which might affect my well
being as a direct or indirect result of my decision to have a tattoo.
I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer
that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and
to any actions or conduct of the representatives and employees of the tattoo shop reasonably
necessary to perform the tattoo procedure.
CLIENT: DATE
ARTIST: DATE
