Tattoo Consent and Health Screening Waiver Form
Complete this form before your tattoo appointment to provide your details, confirm the health screening, and acknowledge the tattoo consent and waiver statement.
Client Information
Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Tattoo Appointment Details
Tattoo Appointment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Artist Name or Studio/Location
*
Tattoo Placement / Body Area
*
Health Screening
Health screening confirmation
*
No current illness or fever
No known allergies to inks or adhesives
Not pregnant
No relevant skin condition or open wound near the tattoo area
I have reviewed this screening and confirm I should not proceed if any listed condition applies
*
Yes
No
Consent, Waiver, and Signature
Consent and Waiver
Client Signature
*
Submit
Submit
Should be Empty: