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0 Union Tattoo & Piercing <br /> ***How did you hear about us? <br /> INFORIVIED CONSENT TO TATTOO <br /> THIS DOCUMENT IS 2 SIDED.PLEASE INTIAL EACH PROVISION ON THE LINES <br /> PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. <br /> In consideration of receiving BODY ART from ,the practitioner at <br /> Union Tattoo, (together with its employees,apprentices,and agents),the"BODY ART <br /> BUSINESS" <br /> confirm the follo 'n by initialing each applicable Item: <br /> _All questions about the body art procedure have been answered to my satisfaction, <br /> and I have been given written aftercare instructions for the procedure I am about to receive. <br /> -------The tattoo described or shown on the client record form is currently drawn to my <br /> -specifications. <br /> -1 understand that tattooing is permanent and that if I choose to have it removed,it <br /> may be expensive and leave scars. <br /> am the person on the legal ID presented as proof that I am at least 18 years of age. <br /> -1 am not under the influence of alcohol or drugs and that I am voluntarily submitting <br /> to be tattooed. <br /> -I understand that there is possibility of an allergic reaction. <br /> -1 understand that there is possibility of getting an infection. <br /> ---_j understand that the FDA has not studied or approved'any tattoo ink. <br /> -1 agree to follow all instructions concerning the care of my tattoo,and that any touch- <br /> ups needed due to my own negligence will be done at my own expense. <br /> understand that there is a chance I may feel lightheaded or dizzy during or after <br /> being tattooed. <br /> -1 agree to immediately notify the artist in the event I feel lightheaded,dizzy,and/or <br /> faint before,during,or after the procedure. <br /> Tf T fAP1/ PP any infprHnn cy n -z I W, consuilt with any e d 0 c,t or. <br /> have been fully informed to the risks of tattooing involving but <br /> not limited to;pigment,latex gloves,and antibiotics.Having been informed of the potential <br /> risks associated with getting tattooed,I still wish to proceed with the tattoo application and <br /> I assume any and all risks that may arise from tattooing. <br /> Signature: Date: <br /> Location on Body of Tattoo/Spelling of Tattoo: <br /> Name of Practitioner(Artist): <br /> Description of Tattoo: <br />