To Induce: e.g. person getting tattoo
Proof of Identity
Attach Image of Current Drivers Licence: Max file size 5MB Allowable formats: (.png), (.jpg) & (.gif)
Appointment Details
Appointment Date: e.g. day/month/year
Appointment Time In:
Appointment Time Out:
Tattoo Price:
GST: 'Effective as of 01/07/2018'
Liability
Do you take all responsibility for the Tattoo procedure and all aftercare? e.g. Yes or No
Client Details
Age:
Date of Birth: e.g. Date - Month - Year
First Name:
Last Name:
Email:
Phone:
Street Address:
Suburb:
State:
Postcode:
Parental Consent - Required if Under 18 years old.
Parent/Guardian Name:
Please write in own words the consent you give:
Please Answer The Following Questions So That We May Better Serve You
Do you release all rights to any photographs / videos taken of the tattoo/s? e.g. Yes or No
Did you request to use a form of numbing cream, spray or gel for your procedure? e.g. Yes or No
Have you eaten within the last 4 hours? e.g. Yes or No
Have you had any alcoholic beverages in the last 8 hours? e.g. Yes or No
Are you prone to fainting? e.g. Yes or No
Are you prone to heavy bleeding? e.g. Yes or No
Do you have to take antibiotics before seeing the dentist? e.g. Yes or No
Have you taken aspirin, ibuprofen, or blood thinners in the last 24hrs? e.g. Yes or No
Do you have a latex allergy? e.g. Yes or No
Are you pregnant or breast feeding? e.g. Yes or No
Do you have any other conditions which might affect the healing of this Tattoo? e.g. Yes or No
Are you allergic to Non-Toxic Pigments, Distilled water, Alcohol, Witch Hazel, Glycol, Isopropyl, Proprietary? e.g. Yes or No
Do you have any other allergies? *if 'YES' specify
Social Media
What is your Instagram username? *for tagging purposes on Instagram. If do not wish to have name tagged to post/s leave this textfield blank.
Tattoo Details
Write a Description of the Tattoo/s:
Where is the Tattoo being placed on body?
Satisfaction
Is the Artwork/s Look, Appearance, Size & Colour/s Correct? e.g. Yes or No
Was the Tattoo stencil placed in correct position? e.g. Yes or No
Was the Tattoo correctly applied? e.g. Yes or No
Did you receive aftercare cream and advised on proper aftercare instructions? e.g. Yes or No
Are you satisfied with the result of your Tattoo? e.g. Yes or No Feedback In your own words leave feedback on Store Hygiene, Quality of work and Tattooist Personality? Signature Do you agree that all information you have input above is correct and true? e.g. Yes or No To complete form please sign/type below your entire name then hit 'Submit Form' located below.
In your own words leave feedback on Store Hygiene, Quality of work and Tattooist Personality?
Signature
Do you agree that all information you have input above is correct and true? e.g. Yes or No
To complete form please sign/type below your entire name then hit 'Submit Form' located below.