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0 <br /> Informed Consent for Permanent Cosmiatics or Tattooing <br /> PLEASE READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND THE <br /> IMPLICATIONS OF SIGNING <br /> in consideration€3f receiving a lattoo from the pro ' "Deer at <br /> Nam of the Pracwwer <br /> _ . <br /> (together with Us employew,apprentices,and agents,the-ratt00 BusineW, <br /> Name of r <br /> I confirm the following: . <br /> _ <br /> All questions about the body art procedure have been answered to my satisfaction, and I have <br /> been given written aftercare instrucctions 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'6xpensive and leave scars. <br /> _I am the person on the legal ID presented roof that I am at least 18 years of age= <br /> 1 not under the influence of d that 1 vol 'y s 9 <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 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 conceming the care of my tartoo, 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 or after being tatt ed. <br /> ® I agree to immediately notify the practitioner in the event I feet lightheaded, dizzy and/or faint <br /> before, during or after the procedure- <br /> p:. <br /> I, have been fully informed of the-risks of . <br /> tattooing including but not limited to infection, "ng, difficulties in detecting mi noma,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 with to procetd 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 <br />