COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

Standard Tattoo Release Form I am at least 18 years old. I don't have a heart condition or history of cardiac valve disease. I don't have epilepsy. I haven't had hepatitis within the last year. I'm not a hemophiliac(bleeder) and I do not have any other bleeding disorders. I'm not under the influence of drugs or alcohol. I don't have a history of herpes infection at the procedure site. No history of allergic reaction to latex or antibiotics. I am aware that inks are not FDA approved and health consequences are unknown. I am not pregnant or breast-feeding. I have not had Botox in the last 45 days And I do not plan on having Botox in the next 45 days. No History of diabetes. I do not have any requirements for antibiotics prior to surgery or dental procedures. No history of diabetes. I do not have requirements for antibiotics prior to surgery or dental procedures. Or have other risk factors for blood borne pathogens. To my knowledge I don't have any physical, mental, or medical impairment or disability, which might affect my well-being as a direct or indirect result of my decision to have any tattoo related work done at this time. I agree to follow all instructions concerning the care of my tattoo while it is healing. I agree that any touch up work needed due to my own negligence will be done at my own expense. If my skin color is dark the colors will not appear as bright as they do a light skin. Being of sound mind and body I hereby release any and all persons representing Makeup Mau Loa from all responsibility. I accept any and all responsibility myself or any consequences that might stem from my decision to have any tattoo related work done by Briana. I agree not to sue in connection with any and all damages, claims, demands, rights, and causes of action of whatever kind or nature, based upon injuries or a property damage to, or death of myself or any other person arising for my decision to have a tattoo related work done at this time, whether or not caused by any negligence of Briana. I agree for myself, my heirs, assigns, and legal representative to hold harmless for all damages, actions, causes of action, claim judgments, cost of litigation, attorney's fees, and all other costs and expenses which might arise from and decisions to have any tattoo related work done by Makeup Mau Loa. I agree to pay for any and all damages and injuries to any and all persons and property belonging to Makeup Mau Loa, Or any other person to whom may become liable contractually or by operation of law, caused by, or resulting from my decision to have any tattoo related work done by BriAna. I agree to leave the premises of Makeup Mau Loa, or any other establishment where is engaged in business promptly upon request, for any reason whatsoever, by any agent or employee of Makeup Mau Loa.