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Perfect Day Tattoo PR2500169 <br /> 521 W. Kettleman Ln. Lodi, CA 95242 <br /> February 5, 2026 <br /> Photo 11: Client consent form with a date of"9/7/26". <br /> PAETFUCT DAY TATT"'O <br /> CONSENT TO TATTOO PROCEDURE <br /> Name, <br /> I <br /> V-7le l- -.--- _D.o.B �&Age dl �� �lv j ID/LicensaNQ.: "t �3LeJ `1 <br /> Phone:"7 & -qOb Address: <br /> I <br /> Da you have any allergies to any antibiotics? (? <br /> L70 you have a history of medication use,or are currently using medication itiouding prescribed antibiafics prior to a surgica#or dental I1V <br /> procedure?Please list. <br /> Do you have HIV,,Hepatitis B,Hepatitis C,Or other risk factors for bloodborno pathogens?/V n <br /> l acknowledge by signing this agreement that f have b n given the full opportunity to ask any and all questions which I might have about <br /> the obtaining of a tattoo and that at]of my questions have been answered to my full satisfaction. <br /> l specifically acknowledge I have been advised Of the foots and matters set forth below and i agree as follows: <br /> EZ/ I do not require antibiotics before surgery or dental procedures. <br /> �f if I have any condition that might affect the healing of this tattoo,I wili advise my tattooer. <br /> am not pregnant,nursing,or under the influence of alcohol or drugs• <br /> ,sunburn <br /> ;��fdo not ha be ethical Or the in co ditions such intOffer with s buid t net limited <br /> f'Ind to:anyetype ntingeclion ar ash anywhere otn mycbody,rI A lei adv se my katt aef. in <br /> the area to <br /> aGnJ If I have any history of hemophelia or other bleeding disorder,diabetes Or any heart conditions such as cardiac valve disease t wilt let the <br /> C possible lot the <br /> I have advised the tattooer of any allergies to metals,latex gloves,soaps and medications.!acknowledge i9 is not reasonably p <br /> tattooer or other employees oI that suShop ch at t determine its pass therl ameetto accept the r have an riisk that such ah eac9an'St possiblegsses involved in <br /> tattoo and further acknowledge <br /> I accept aftercare instructions and I agree to follow them while my tattoo is healing.Si,ns o1 infection include but are not limited to'.redness, <br /> that an touch up work needed,due to my own negirgence,will be done at my awn expense. <br /> swelling,tenderness,red streaks towards 8eheart,elevated body tempeature,puful®nt drainage from procedure site.it V experience signs <br /> symptoms I will seek medical attention. g lied to my body i understand <br /> : .ti.i,—An env tattoo as selected by me and as ultimately app <br /> Alexander Cruz, REHS 11 <br />