Consent Form – Dandy Tattoo

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Aftercare
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Consent Form

About
Aftercare
Payments
Gallery
Consent Form

DANDY CLIENT CONSENT FORM

Client Information

First Name *(and preferred pronouns)

Last Name *

Instagram

Street Address *

Postcode *

Email Address *

Phone *

Short Description of Tattoo *0 / 180

Medical History

1. Do you take any prescribed medications? (Especially blood thinners/steroids) *YesNo

Please Elaborate *

2. Do you have any allergies (e.g. latex, plasters, creams, metals, food etc.) *YesNo

Please Elaborate *

3. Are you Diabetic? *YesNo

How is it controlled? *

4. Are you Pregnant or Breastfeeding? *YesNo

Please Elaborate *

5. Do you Suffer from Epilepsy or Seizures? *YesNo

Please Elaborate *

6. Any Heart Conditions? *YesNo

Please Elaborate *

7. Do you suffer from any blood related disorders (clotting, haemophilia, any blood borne virus etc.) *YesNo

Please Elaborate *

8. Do you suffer from Lupus or any other autoimmune condition? *YesNo

Please Elaborate *

9. Do you have any skin conditions? *YesNo

Please Elaborate *

10. Any scarring issues (e.g. keloids)? *YesNo

Please Elaborate *

11. Any known previous reaction to dye pigments? *YesNo

Please Elaborate *

12. Do you have a history of fainting? *YesNo

Please Elaborate *

13. Any Other relevant Information I Should KnowNeeds, accommodations, concerns, anything at all

Declaration

I declare that I give my full consent to tattooing being carried out by Dandy Tattoo. I confirm that potential complications (E.g. infection, swelling) have been explained to me, as well as aftercare instructions. A written aftercare advice sheet containing more detailed information has been given to me and I agree that it is my responsibility to read this and follow instructions on it, until the site has healed. *Yes

I confirm that the above information provided by me for this consent form is correct to the best of my knowledge, that I am over the age of 18, and I am not currently under the influence of drugs or alcohol. *Yes

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About
Aftercare
Payments
Gallery
Consent Form

About
Aftercare
Payments
Gallery
Consent Form

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