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BODY ART CONSENT AND HEALTH

DISCLOSURE FORM FOR TATTOOING


Technician: Tayla Kim License #: 319470

Client Info

Type of identification Provided

Medical History

Please check any conditions that apply to you:
Do you have any additional allergies such as to metals, soaps, cosmetics, or alcohol?
Yes
No
Do you have any condition that requires you to take medications such as anticoagulants that thin the blood or interfere with blood clotting?
Yes
No
Have you ever been prescribed antibiotics prior to dental or surgical procedures?
Yes
No
Do you have any other medical or skin conditions that might affect the outcome of this procedure?
Yes
No
Do you have any cardiac valve diseases?
Yes
No

Informed consent to receive body art

PLEASE READ AND CHECK THE BOX WHEN YOU ARE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING.


In consideration of receiving BODY ART from, Tayla Kim

The practitioner at Eternal.ink

(together with its employees and other technicians, the "Establishment")


please read and check each box

understand the risks of body art the risks of body art including but not limited to infection, scarring, and allergic reactions to items associated with body art procedures. Technician will not perform the body art procedure if you fail to complete or sign this form. Further, technician may decline to perform a body art procedure if the client has any identified health conditions. Having been informed of the potential risks associated with

this body art procedure, I still wish to proceed with the body art application and I assume any/all risks that may arise from body art.


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signing acknowledges this form and the Client Treatment Consent and Release

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