Vivid Ink || Consent Form

Vivid Ink Consent Form v1.0 (BETA)

Hi there, please fill out and submit this form.

About You:

Please provide us some information about you

Name*

Email*

Full Address*

Phone number*

Date of Birth*

Service Type*

Tattoo Piercing Laser Treatment

Please choose a studio* Please choose an artist*

Health Details:

Do you have Hepatitis*

Yes No

Hepatitis Details*

Are you under the influence of alcohol or illegal drugs.*

Yes No

influence of alcohol or illegal drugs details*

Do you have Epilepsy.*

Yes No

Epilepsy Details*

Are you a Hemophiliac (bleeder)*

Yes No

Hemophiliac (bleeder) Details*

Do you have to take blood thinners*

Yes No

Blood thinners Details *

Do you have HIV*

Yes No

Do you have Diabetes*

Yes No

Do you have any allergies*

Yes No

Are you Pregnant*

Yes No

Physical, mental or medical impairment*
(To my knowledge do you have any physical, mental or medical impairment, which may affect my well being as a direct or indirect result of my decision to have any tattoo related work performed on me)

Yes No

Physical, mental or medical impairment details*

Aftercare Instructions*
(I agree to follow all instructions concerning the care of my tattoo whilst it is healing and afterwards)

Yes No

Photography*

Yes No

I agree further sessions can be completed using this release form subject to the above answers remaining the same.*

Yes No

Responsibility*
(I accept any and all responsibility for any consequences that might stem from my decision to have any work done by a representative at Vivid Ink)

Yes No

Valid ID*
(All clients must be able to provide a valid I.D. if asked.)

Yes No

Marketing*
(As a customer of Vivid Ink, subscribe to receive, priority bookings, exclusive give aways, informative guidance, early news plus much more.)

Yes No

Apprentice Tattoo Artist
(Is your tattoo being completed by an Apprentice) *

Apprentice Disclaimer* I understand that I am being tattooed by a junior tattoo artist therefore paying a reduced hourly rate for their service, due to their lack of experience. I will not hold them or Vivid Ink responsible for any mistakes that could occur during the tattoo process.

I agree

Where did you hear about us?* Please us know where you found of about Vivid Ink

Instagram Facebook Google Search Word of Mouth Website Other

Agree and Sign*

I HAVE READ AND UNDERSTOOD EACH OF THE ABOVE PARAGRAPHS

Signature*

Review:

Thank You!

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