• Tattoo Authorization Form

• Client Information
• First and Last Name
• Birth Date
• Phone

  --
• Email
• Street Address
• Apt/Unit
• City
• State
• Zip Code
• Questionnaire
• Do you have any skin conditions?

  Yes No
• Do you have any diseases?

  Yes No
• Are you over the age of 21?

  Yes No
• Are you under the influence of any drugs or alcohol?

  Yes No
• Are you pregnant or nursing? (Women only)

  Yes No
• Please list/explain any skin conditions
• Acknowledgment and Waiver

  
  

  I, , agree to all of the following:

  
  

  • I understand that this tattoo is a permanent change to my skin/body. 
  • I understand there are no refunds. 
  • I understand that I must take care of my tattoo after procedure and the shop is not liable for any allergic reactions/infections. 
  • I will not pursue any legal action if I am to experience any kind of infection due to lack of care of my tattoo. 
  • I confirm that all of the information I have given to the shop is accurate. 
• Signature*
• Date*