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STATEMENT OF CONSENT AND RECITALS PLEASE READ AND INITIAL ALL LINES AFTERCARE INSTRUCTINS HAVE BEEN EXPLAINED TO ME AND A WRITTEN COPY WILL BE GIVEN TO ME TO RETAIN IN MY POSSESSION, WHICH I WILL FOLLOW TO THE BEST OF MY ABILITY. IF I HAVE QUESTIONS I WILL CALL, TEXT, OR EMAIL YOU. I UNDERSTAND THAT A CERTAIN AMOUNT OF DISCOMFORT IS ASSOCIATED WITH THIS PROCEDURE AND THAT SWELLING, REDNESS AND BRUISING MAY OCCUR. I UNDERSTAND THAT SUN,TANNING BEDS, POOLS, SOME SKIN CARE PRODUCTS AND MEDICATIONS CAN AFFECT MY TATTOO. I WILL TELL ALL SKIN CARE PROFEFESSIONALS OR MEDICAL PERSONNEL ABOUT MY TATTOO PROCEDURES, ESPECIALLY IF I'M SCHEDULE FOR AN MRI. I ACCEPT THE RESPONSIBILITY OF EXPLAIN TO YOU MY DESIRE FOR SPECIFIC DESIGN, COLORS, SIZE AND PLACEMENTS FOR ANY TATTOO PROCEDURE DONE TODAY. I UNDERSTAND THAT IMPLANTED PIGMENT COLOR CAN SLIGHTLY CHANGE OR FADE OVER TIME DUE TO CIRCUMSTANCES BEYOND YOUR CONTROL AND I WILL NEED TO MAINTAIN THE COLOR WITH FUTURE APPLICATIONS. I ACKNOWLEDGE THAT THE PROPOSED PROCEDURE(S) INVOLVED RISKS INHERENT IN THE PROCEDURE AND HAVE POSSIBILITIES OF COMPLICATIONS DURING AND/OR FOLLOWING THE PROCEDURES SUCH AS: INFECTIONS, MISPLACED PIGMENT AND POOR COLOR RETENTION. I HAVE BEEN QUOTED THE COST OF TODAY'S APPOINTMENT(COST IS DECIDED BASED ON SIZE, COMPLEXITY AND PLACEMENS OF THE TATTOO). I ACCEPT FULL RESPONSIBILITY FOR THE DECISION TO HAVE THIS TATTOO PROCEDURE(S) DONE. I CERTIFY THAT I HAVE READ OR HAVE HAD READ TO ME THE CONTENTS OF THIS FORM. I UNDERSTAND THE RISKS AND ALTERNATIVES INVOLVED IN THIS PROCEDURE(S) AND I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS AND ALL OF MY QUESTIONS HAVE BEEN ANSWERED. I ACKNOWLEDGE THAT I HAVE REVIEWED AND APPROVED THE MATERIAL GIVEN TO ME AND I AUTHORIZE ' AS MY TATTOO ARTIST/TECHNICIAN TO PERFORM ON MY BODY THE PROCEDURES INDICATED ON PAGE 1 OF TATTOO CONSENT FORM. NAME: SIGNATURE: DATE: 4