ONLINE CONSENT FORM | Zink Modern Tattooing

TATTOO CONSENT FORM

Save paper and time by filling out this form online. Only available for adults 18 years and older. Minors must print out our form, have it notarized and bring it to your appointment along with a parent.

FULL NAME

PREFERRED NAME (if different than legal name)

STREET ADDRESS

CITY

STATE

ZIP CODE

DESCRIPTION OF TATTOO

APPT DATE required

PHONE

BIRTH DATE

EMERGENCY CONTACT NAME & PHONE

LOCATION OF TATTOO

I am 18 years of age or older. I accept full responsibility for the administration and willing participation in the act of receiving a tattoo by Zink Modern Tattooing wherein the tattoo described above will be placed on my body on the specified area. I furthermore release and give up any claims against Zink Modern Tattooing, or any agents, servants, employees, officers or directors of said corporation resulting out of any health problems that may result from negligence in the care of said tattoo. More particularly, I acknowledge that I freely and voluntarily have chosen the type of tattoo received and the location of the same.

I do not (to my knowledge) now have or have had any of the following diseases: Diabetes, Allergies, Hepatitis, Heart Disease, Acquired Immune Deficiency Syndrome (AIDS), Hemophilia, Venereal Disease, Skin Conditions such as Eczema or Psoriasis or any other communicable diseases. I am also not on any medications that will hinder the application or healing of my tattoo, such as Accutane or blood thinners. I fully understand and agree to be bound by the terms contained herein. I do hereby certify all representations made by me are true. If I have any medical conditions, I agree to list them on this form.

PERTINENT MEDICAL CONDITIONS

I acknowledge that I have read and understand the proper aftercare procedures listed on this website's AFTERCARE page.

I agree that my electronic signature has the full force and effect of a signature affixed by hand to a paper document

ELECTRONIC SIGNATURE