Portland Tattoo Co Consent Waiver and Medical Release

First Name *

Last Name *

Date of birth *

Phone *

Email *

Address *

City *

State *

Postal code *

Tattoo Design *

Are there any other known MEDICAL CONDITIONS or CONTAGIOUS DISEASES that may affect your TATTOO procedure?

Photo ID *

Have we answered all your questions? *

All questions have been answered to my satisfaction.

Do you understand the tattoo is permanent? *

I understand that the said TATTOO is PERMANENT.

Are you at least 18? *

This is to certify that I am at least 18 YEARS OF AGE.

Do you agree you are not under the influencer of alcohol or drugs? *

I am not under the influence of ALCOHOL or DRUGS.

Do you understand allergic reactions are possible? *

I understand there is a possibility of an allergic reaction.

Are you of sound mind and body and choose to get this tattoo? *

I am of sound mind and body, and I am choosing to get a tattoo under my own free will.

Will you follow all aftercare instructions? *

I agree to follow all instructions concerning the aftercare of my TATTOO.

Do you understand you may feel lightheaded, dizzy, and/or faint? *

I understand there is a chance I might feel lightheaded, dizzy and/or faint due to my decision to receive a TATTOO.

Will you immediately notify us if you feel any of these symptoms? *

I agree to immediately notify the artist in the event I feel lightheaded, dizzy and / or faint before, during or after the procedure. Failure to do so releases Portland Tattoo Co of ALL RESPONSIBILITY.

Do you release us of liability? *

I hereby release Portland Tattoo Co of ALL RESPONSIBILITY for the said TATTOO.

Do you understand the refund policy? *

I understand there are NO REFUNDS.

Do you understand materials are not FDA approved? *

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

Do you give consent for this tattoo? *

By checking this box, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the ‘Agree & Complete’ button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.

Signature *

Clear

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Medical History Consent and Release Form for Tattoo