Laserfiche WebLink
Pain/Healing Acknowledgment Medical Questionnaire(Check Yes or No) <br /> V I understand the tattoo procedure involves piercing the skin with needles and may Are you 18 or older? Yes V No V <br /> cause pain, swelling, redness, and scabbing. Healing varies by individual. History of herpes infection at the procedure site? Yes O No <br /> Client Initials: History of diabetes? Yes Q No 0 <br /> Allergic reaction to latex? Yes Q No 0 <br /> Aftercare Instructions Allergic reaction to antibiotics? Yes Q No Q <br /> History of hemophilia/bleeding disorders? Yes 0 No Z) <br /> Q Wash gently with clean hands, mild soap, and lukewarm water. Do not scrub. History of cardiac valve disease? Yes V No <br /> 0 Pat dry with a clean paper towel. Current medications (list): <br /> Apply a thin layer of approved ointment(if advised by your artist). Require antibiotics before surgery/dental work? yes 0 No Q <br /> Do not submerge tattoo in water(baths, swimming, hot tubs)until healed. Risk factors for blood-borne pathogens (rV drug use, hepatitis,HIV, etc.)? <br /> Avoid direct sunlight and tanning beds until healed. <br /> Yes ONoO <br /> Restrictions: <br /> 0 I have disclosed all relevant medical history and understand that withholding <br /> Avoid heavy exercise, sweating, or tight clothing for the first few days. Do not pick, information may increase health risks. <br /> scratch, or peel scabs. <br /> Signs of infection: Redness, warmth, swelling, pus-like drainage, increasing pain, or Client Initials: <br /> fever. <br /> Seek medical care if: spreading redness_ fever, chills, pus drainage. or complications due Photo/Media Consent <br /> to health conditions. <br /> I agree to follow the aftercare instructions provided to and accept that improper I consent to photos/videos of my tattoo being taken and used for the artist's portfolio,advertising, or <br /> 0 <br /> social media. <br /> aftercare can cause infection,fading, or scarring. Q I do not consent to photos/videos of my tattoo being taken or used for the artist's portfolio, advertising, <br /> or social media. <br /> Client Initials: <br />