!TATTOO DISCLOSURE STATEMENT AND CONSENT FORM

 

• As with any invasive procedure, tattooing may involve possible health risks. These risks may include: pain, bleeding, swelling, scarring, hypertrophic scarring, keloid formation, possible adverse or allergic reaction to ink / dye / pigment, decreased ability of a physician to locate skin melanoma in the tattoo area, possible nerve damage, febrile (fever) illness, tetanus, and infection - local or systemic.

 • Unsterile equipment and needles can spread infectious diseases and it is extremely important to be sure that all equipment is clean and sanitary before use.

• The inks, or dyes, used for tattoos are color additives. Currently, no color additives have been approved by the FDA for tattoos.

• Tattoos should be considered permanent so make sure you are 100% positive about your choice. Removal of a tattoo may require surgery or other medical procedures which in some cases may result in scarring or additional scarring of the skin. Tattoos may cause permanent discoloration. Inks / dyes / pigments may change color over time.

• Blood donations cannot be made for one year after getting a tattoo.

 

HEALTH HISTORY

The following conditions may increase health risks associated with receiving a tattoo: hemophilia (bleeding), skin diseases, lesions, or skin sensitivities to soaps/disinfectants etc, history of allergies or adverse reactions to pigments, dyes, or other sensitivities, history of epilepsy, seizures, fainting, or narcolepsy, use of medications such as anticoagulants, (such as coumadin) which thin the blood and/or interfere with blood clotting, and hepatitis or HIV infection.

 

RECOMMENDED INSTRUCTIONS FOR THE AFTERCARE OF TATTOOS

Note: Your tattoo practitioner's instructions may vary from these.

Treat your new tattoo as an open wound. Keep it clean. Do not touch healing tattoos with dirty hands. Before cleaning the tattooed area, wash hands thoroughly with soap and warm water. Carefully remove the bandage and tape. Do not rip it off. Using mild soap and coot water, gently and carefully cleanse the area, and pat dry. Do not rub with a washcloth or towel. Apply a thin layer of antibiotic ointment (Bacitracin, Neomycin-Polymyxin) over the tattoo. Repeat cleansing and application of the antibiotic ointment 2-4 times a day for 3 days. Healing usually takes 7 to 10 days, depending on the size of the tattoo. As it heals, expect peeling like with sunburned skin. Do not pick at scabs. Avoid getting sunburned, salt or chlorinated pool water, hot tubs, saunas and steam baths while the tattoo is healing. Itching is expected but do not scratch the tattoo. Consult a health care provider if you experience any of the following unexpected redness, tenderness, or swelling at the site of the tattoo, rash,unexpected drainage at or from the site of the tattoo, or fever within 24 hours of getting the tattoo.



  • “I have read and understand the above information.

  • I do not have a condition that prevents me from receiving a tattoo.

  • I am not under the influence of any drug(s) or alcohol.

  • I am not pregnant and don’t suspect that I may be pregnant.

  • I understand my information will be kept confidential.

  • I understand that the artist is a licensed Professional Tattoo Artist 

  • I give my consent to this artist to perform body art on me.

  • I take responsibility for the work of the tattoo artist.

  • I am over 18 (if I am younger than 18 then I have parental consent and their information is provided below).

  • I consent to the performance of the tattooing procedure and I have given verbal and written aftercare instructions.

  • I take responsibility for this document.

 

Please check any conditions listed below that apply to you.

Diabetes

Hemophilia

T.B.

Asthma

Epilepsy

Blood Thinners

Eczema/Psoriasis

Allergy/Sensitivity to Latex

Fainting and Dizziness

Herpes

Scarring/Keloiding

Allergic reactions to antibiotics

Heart Condition

Pregnancy/Nursing

Skin Conditions

Bleeding Disorder

Tenderness

HBV

Fever

Other


  

 

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