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Artistic Binge PR0547582 <br /> 1537 Second St. Escalon, CA 95320 <br /> March 9, 2026 <br /> Photo 16: Client consent form missing artist name at the top of the page. <br /> t <br /> iron of recerving a tattoo trorn co{� the ro iowing' at Artistic riinge stuoio. <br /> h / re Want <br /> -.,rc geeh:yr sm not P g ry <br /> DO Y-u have any a11,�dO r of have a history of herpes infection at the proposed procedure site,diabetes,allergic <br /> Do YOU Use ons to latex or antibiotics, hemophilia or other bleeding disorders,or cardiac valve disease.receive? �ITyrR' re do not have a history of medications use and am not currently using medication,including being <br /> p ribed antibiotics prior to dental or surgical procedures. a <br /> re <br /> Do you have All questions about the body art procedure have been answered to my satisfaction,and I have <br /> procedure?_ beB�n given written aftercare instructions for the tattoo I am about to receive. <br /> NavOu evr �V/ he tattoo described or shown on the client consent form is correctly drawn to my specifications. <br /> understand that tattooing is permanent and that if I choose to have it removed,it may be <br /> Are fh exp/�nsive and leave scars. <br /> body artist`s v,,i am the person on the legal ID presented as proof that I am at least 18 years of age <br /> —V 1 am not under the influence of alcohol or drugs and that I am voluntarily submitting to be tattooed <br /> CO yy CO)R r w�rt�ut duress of coercion. <br /> 1 aCC@ —Vi understand there is a possibility of an allergic reaction to the inks and pigments commonly used <br /> pt th in tattooing. <br /> Signature: -/ understand that all tattoo Inks are not FDA approved and health consequences are unknown. <br /> l _.lLI understand there is a possibility of getting an infection and i have been advised of the signs and! syry�ptoms of infection that indicate a need to seek medical attention. <br /> I V I agree to follow ail instructions concerning the care of my tattoo, and that any touch ups needed <br /> bemuse of my own negligence will be done at my own expense <br /> V I understand that there is a chance I might feel lightheaded,dizzy and/or faint before,during,or <br /> after procedure. <br /> Q�ey <br /> AIL t have been fully informed of the risk of tattooing <br /> including but not limited to risk factors for bioodborne pathogen exposure, infection and other medical <br /> complications, allergic reactions to metal, latex gloves and antibiotics. Having been informed of the <br /> potential risks associated with receiving a tattoo and I still wish to proceed with the procedure. I <br /> assume all risk that may arise from the tattoo procedure. <br /> On completion of your tattoo, it is typical to experience slight swelling, redness itching and discomfort. <br /> You notice small amounts of excess ink along with blood and fluid leaking.These symptoms typically <br /> subside after 3 days. Plea se see attached aftercare procedure fo m for more details on care and <br /> signs to t o rtisAaseeking medical care. <br /> Signed: Date <br /> Alexander Cruz, REHS 16 <br />