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Informed Consent for Permanent Cosmetics or Tattooing <br /> PLEASE READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND THE <br /> IMPLICATIONS OF SIGNING <br /> In consideration of receiving a taboo from Pthe practitioner at <br /> of the ractitioner <br /> - (together with its employees,apprentices,and agents,the"Tattoo Business", <br /> Narne of Tattoo Business <br /> I confirm the following: <br /> All questions about the body art procedure have been answered to my satisfaction, and 1, have <br /> been given written aftercare instructions for the tattoo I am about to receive. <br /> The tattoo described or shown on the Client record form is correctly drawn to my specifications. <br /> I understand that tattooing is permanent and that if I choose to have it removed, it may <br /> be expensive and leave scars. <br /> I am the person on the legal ID presented as proof that I am at least 18 years of age. <br /> I am not under the influence of alcohol or drugs and that I am voluntarily submitting <br /> to be tattooed without duress or coercion. <br /> I understand there is a possibility of an allergic reaction to the inks and pigments commonly <br /> used in tattooing. <br /> I understand there is a possibility of getting an infection, and I have been advised of the signs <br /> and symptoms of infection that indicate a need to seek medical attention. <br /> I agree to follow all Instructions concerning the care of my tattoo, and that any touch-ups <br /> needed because of my own negligence will be done at my own expense. <br /> I understand that there is a chance I might feel lightheaded, dizzy during ora er being tattooed. <br /> I agree to immediately notify the practitioner in the event I feel lightheaded, dizzy and/or faint <br /> before, during or after the procedure. <br /> have been fully informed of the risks of <br /> Jaom <br /> tattooing including but not limited to infection, scarring, difficulties in detecting me na, and <br /> allergic reactions to tattoo pigment, latex gloves, and antibiotics. Having been informed of the <br /> potential risks associated with getting a tattoo, I still wish to proceed with tattoo application and I <br /> assume any and all risks that may arise from tattooing. <br /> Signed Date <br /> Permanent Cosmetics and Tattooing Page 3 of 3 <br />