SR0083901_3/8/2022 - Laserfiche WebLink

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READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING THIS DOCUMENT In consideration of receiving a tattoo from at Artistic Binge Studio. I confirm the following: am not pregnant I do not have a history of herpes infection at the proposed procedure site, diabetes, allergic reactions to latex or antibiotics, hemophilia or other bleeding disorders or cardiac valve disease. do not have a history of medications use or am currently using medication, including being prescribed antibiotics prior to dental or surgical procedures. All questions about the body art procedure have been answered to my satisfaction, and I have been given written aftercare instructions for the tattoo I am about to receive. The tattoo described or shown on the client consent form is correctly drawn to my specifications. understand that tattooing is permanent and that if I choose to have it removed, it may be expensive and leave scars. I am the person on the legal ID presented as proof that I am at least 18 years of age am not under the influence of alcohol or drugs and that I am voluntarily submitting to be tattooed without duress or coercion. I understand there is a possibility of an allergic reaction to the inks and pigments commonly used in tattooing. I understand that all tattoo Inks are not FDA approved and health consequences are unknown. understand there is a possibility of getting an infection and I have been advised of the signs and symptoms of infection that indicate a need to seek medical attention. I agree to follow all instructions concerning the care of my tattoo, and that any touch ups needed because of my own negligence will be done at my own expense understand that there is a chance I might feel lightheaded, dizzy and/ or faint, before, during or after procedure. I, have been fully informed of the risk of tattooing including but not limited to risk factors for bloodborne pathogen exposure, infection and other medical complications, allergic reactions to metal, latex gloves and antibiotics. Having been informed of the potential risks associated with receiving a tattoo and I still wish to proceed with the procedure. I assume all risk that may arise from the tattoo procedure. On completion of your tattoo, it is typical to experience slight swelling, redness itching and discomfort. You notice small amounts of excess ink along with blood and fluid leaking. These symptoms typically subside after 3 days. Please see attached aftercare procedure form for more details on care and signs to contact your artist and seeking medical care.