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TATTOOING CONSENT FORM

Check off any and all of the following which apply to you:





By signing this form I agree to the following:

I agree to follow all verbal and/or written instructions concerning the care of my tattoo. Any touch-up work that needs to be done due to my own negligence will be at my own expense. This includes using things like numbing cream. If my skin is dark, it will affect the intensity and color of the tattoo. I do not have Any mental, physical, or medical impairment which may affect my judgment or my well-being as a direct or indirect result of my Decision to have tattoo work performed at this time. Keepsake Custome Tattoo Inc. and it's artists, contractors, and employees should not be held responsible for any claims, damages, actions, judgments, litigation costs, attorney’s fees, and all other cost expenses which might arise from my decision to have a tattoo work done at this time.

By signing this form, I hereby certify that, to the best of my knowledge, the information I have provided is correct. I certify that I am at least 18 years of age and will provide legal identification to be photocopied and attached to this form. I certify that all questions have been answered to my satisfaction. By submitting this form I release all rights to any photographs/videos taken of me and my tattoos. I also give consent in advance to their reproduction in prints and social media.

Free Touch-up Policy

I acknowledge that tattoos done on scars, cover up tattoos, black out tattoos, finger tattoos, hand tattoos and feet tattoos often require a touch-up or a re-do within days or weeks of getting them done. I understand these are problematic areas and situations. These types of tattoos often do not hold as well as other spots on the body and require more work after healing. If I need tattoos mentioned above touched up, it would be at a full cost of whatever time it takes to do them. This explantion is in addition to the appointment info provided in your appointment information texted to you and emailed to you after booking.

Numbing Cream Policy

I agree that if I use a numbing cream or any other 3rd party product, I do so at my own risk, assuming all responsibility for any reaction or poor healing and sacrificing my free touch-up. We will not do free touch-ups on a tattoo that healed poorly due to numbing cream.


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BOARD OF HEALTH - BODY ART DISCLOSURE STATEMENTS

THIS STATEMENT IS TO BE GIVEN TO ALL BODY ART CLIENTS, AND IS TO BE SIGNED BY THE CLIENT, PRIOR TO PERFORMING ANY BODY ART PROCEDURE

TATTOO DISCLOSURE STATEMENT

As with any invasive procedure, tattooing may involve possible health risks. These risks may include: Pain, bleeding, swelling, infection scarring of the area, and nerve damage.

Pain, bleeding, swelling, infection scarring of the area, and nerve damage. Un-sterile equipment and needles can spread infectious diseases; it is extremely important to be sure that all equipment is clean and sanitary before a use. Tattoos and permanent makeup are not easily removed and, in some cases, may cause permanent discoloration. Think carefully before getting a tattoo. There is also the possibility of an allergic reaction. The inks or dyes used for tattoos are color additives. Currently, no color additives have been approved by FDA for tattoos, including those used in permanent makeup. Blood donations cannot be made for a year after getting a tattoo or permanent makeup.

THE BODY ART PRACTITIONER SHOULD

Properly and thoroughly cleanse the area before the procedure. Use sterilized equipment. Use sterile techniques. Provide information on the aftercare of the area receiving body art.

HEALTH HISTORY AND INFORMED CONSENT

The following conditions may increase health risks associated with receiving body art:

  1. diabetes
  2. hemophilia (bleeding)
  3. skin diseases, lesions, or skin sensitivities to soaps, disinfectants etc.
  4. history of allergies or adverse reactions to pigments, dyes, or other sensitivities
  5. history of epilepsy, seizures, fainting, or narcolepsy;
  6. use of medications such as anticoagulants. (such as coumadin) which thin the blood and/or interfere with blood clotting; and
  7. hepatitis or HIV infection

PROCEDURE FOR FILING A COMPLAINT

If there is any injury, infection,complication or disease as a result of a body art procedure notify this establishment and the following local board of health at Salisbury Health Dept., 5 Beach Road, Salisbury, Massachusetts 01952.

I have received the above information; I do not have a condition that prevents me from receiving body art. I consent to the performance of the body art procedure and have been given written and verbal aftercare instructions as required by these regulations.