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0 <br /> INFORMED CONSENT TO BODY ART <br /> PLEASE READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND <br /> THE IMPLICATIONS OF SIGNING <br /> In consideration of receiving BODY ART from the practitioner <br /> at (together with its employees,apprentices,and agents,the"Body Art Business") <br /> I confirm the following by initialing each applicable item: <br /> Client's name <br /> All questions about the body art procedure have been answered to my satisfaction, and I <br /> have been given written aftercare instructions for the procedure I am about to receive. <br /> The body piercing described or shown on the client record form is correctly placed to my <br /> specifications. <br /> The tattoo described or shown on the client record form is correctly drawn to my <br /> 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. <br /> I understand there is a possibility of getting an infection. <br /> I agree to follow all instructions concerning the care of my tattoo, and that any touch-ups <br /> needed due to 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 <br /> tattooed. <br /> I agree to immediately notify the artist 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 /> tattooing including but not limited to infection, scarring, difficulties in detecting melanoma, and allergic <br /> reactions to tattoo pigment, latex gloves, and antibiotics. Having been informed of the potential risks <br /> associated with getting a tattoo, I still wish to proceed with tattoo application and I assume any and all <br /> risks that may arise from tattooing. <br /> Signed Date <br /> ARTIST USE ONLY ARTIST USE ONLY Hours x $120=$ <br /> SS TUBE TYPE BATCH# DATE Deposit $ <br /> DISPOSABLE 3R 5R 7R 7M 11 M 13M 15M OTHER Total <br />