Consent Form | Blue Dragon

BODY ART CONSENT FORM

Fully complete this form prior to being tattooed, pierced, or getting a tooth gem

First name

Last name

PHONE

Addess Line One

Address Line 2

City

Zip Code

State

Date of Birth

Do You Have A Fever Or Any Cold Or Flu Symptoms

Yes.

Thanks you!

Estimate Price

CONSENT TO TATTOO APPLICATION, OR PIERCING, OR TOOTH GEMMING, RELEASE AND WAIVER OF ALL CLAIMS I acknowledge by signing this release that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo procedure, or piercing. or tooth gemming, from (previously specified technician)( hereafter called “Technician”) and that all of my questions have been answered to my full and total satisfaction. Procedure to be performed: Permanent Tattoo, or piercing. or tooth gemming. I specifically acknowledge that I have been advised of the matters set forth below and agree as follows:

I acknowledge that obtaining a tattoo, or piercing, or tooth gemming procedure is my choice alone and. The application of a tattoo procedure will result in a permanent change to my appearance, and that needles and inks will go into my skin. No representations have been made to me as to the ability to later restore the skin involved in a tattoo procedure to the original condition, and it is very costly to remove

I am not pregnant or nursing. I do not have any history of herpes infection at the proposed procedure site. I do not have epilepsy, diabetes, allergic reaction to latex or antibiotics, hemophilia or other bleeding disorder. I do not have cardiac valve disease or suffer from any heart conditions or take medications that thins my blood.

If I suffer from hepatitis, or other risk factors for bloodborne pathogen exposure, or any other communicable disease, I have informed the Technician of the fact and have been advised of any medications and procedure necessary to promote the satisfactory healing of my tattoo.

I do not suffer from any medical or skin condition(s) such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the tattoo, or piercing, or tooth gemming procedure area, or any open wounds or lesions at the site of the tattoo.

I do not have a history of medication use or currently using medication, including being prescribed antibiotics prior to dental or surgical procedures.

I have advised the Technician of any allergies to latex gloves, soaps, or medications. I acknowledge it is not reasonably possible for the Technician to determine whether I might have allergic reaction to the tattoo or piercing process and further acknowledge that such reaction is possible.

I have truthfully represented to the Technician that I am 18 years of age or older. I am not under the influence of any drugs or alcohol. To my knowledge, I do not have any physical, mental, or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have a tattoo or a piercing at this time

I acknowledge infection is always possible as a result of a tattoo, or piercing, or tooth gemming procedure application, and I agree to follow all suggested instructions concerning the care of the tattoo, or piercing, or tooth gemming procedure site while it is healing.

I acknowledge and give consent to this tattoo studio to use images of my tattoo(s), or piercing(s), or tooth gemming(s) for marketing and, or publishing purposes in various media such as the internet, magazine, printed, and or television etc.

I understand I will have a tattoo, or piercing, or tooth gemming procedure applied using appropriate instruments and sterilization techniques. I understand that the tattoo procedure site usually takes 2 weeks or longer to heal piercings 2 months or longer to heal. I agree to release and forever discharge, and hold harmless, the Technician, all employees, contractors, and the management of the tattoo procedure studio from any and all claims of negligence, damages, or legal actions arising from or connected in any way with my tattoo, the procedure, and conduct used in my tattoo and assume all responsibility for the decision(s) made consenting to this permanent procedure.

I am aware that tattoo inks, dyes, and pigments have not been approved by the federal Food and Drug Administration and that the health consequences of using these products are unknown.

Electronic Signature Authorization By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable. By electronically signing and submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2) voluntarily agree to be bound by this agreement; and 3) certify that I am 18 years of age or older. My signature applies to all pages of this contract. I understand that I will receive a Portable Document Format (PDF) version of this agreement after it is signed at the email address I have provided. To view the PDF document, I understand that I will need software that enables me to receive and access PDF files such as Adobe Reader software or other software capable of reading a PDF file. In order to print and retain a hard copy of this agreement, I understand that I will also need a printer connected to my computer. I understand that if I wish to sign a hard copy of this agreement instead of an electronic version, I must contact the party that requires my signature on this agreement directly.

If I am signing this consent form for a minor under the age of 18 years old (Piercing Only) I give my consent for said minor to obtain a body piercing. As said parent or guardian I state under penalty of law that I have truthfully represented my age and my relationship to the minor with a valid government issued ID (Applicable only to underage body piercing.

Electronic Consent Signature (Enter Your Name)*

CLICK HERE TO BOOK OR CALL (323) 531-4030 OR (323)531-4030

Blu Dragon Tattoo

BODY ART CONSENT FORM

(323) 531-4030

(323)744-2023