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Tattoo & Piercing

Client Record.

Complete the customer record, medical screening, procedure information, and acknowledgement before your procedure.

All tattoos and piercings will be photographed, no exceptions.
Printer-Friendly 8.5 x 11 Form

Read the information that applies to your procedure before acknowledging the form.

01 Customer Information
02 Emergency & Physician Information
03 Medical Screening Questionnaire

Please respond to each question by selecting Yes or No.

1. History of jaundice or hepatitis?

2. History of aids or positive HIV tests?

3. History of skin disease or skin cancer at the site of service?

4. History of allergies or anaphylactic reaction to pigments dyes or other sensitivities?

5. History of hemophilia (bleeder)?

6. History of diabetes?

7. Currently taking medications which thin the blood and prevent clotting?

8. Currently pregnant or under the influence of drugs or alcohol?

9. History of any other known medical condition, which would influence or impair the healing process?

04 Procedural Information

Tattoos

Procedural information regarding your tattoo:

  • The area to be tattooed might need to be shaved.
  • The area will be cleaned with an antibacterial soap.
  • A stencil of the design will usually be applied at this time, although the design may be drawn by hand.
  • While the stencil is drying, the artist will be setting up necessary inks, sterilized needles and equipment.
  • The tattoo in rendered into the skin on color at a time using needles.
  • Larger pieces may be done in more than one sitting.
  • Tattoo is cleaned with an antibacterial soap and a bandage is applied to the fresh tattoo.
  • IT IS UP TO YOU TO TAKE PROPER CARE OF THE TATTOO. READ AFTERCARE INSTRUCTIONS.
  • Some soreness, bruising and scabbing are common during the healing period, but if proper care is taken, complications are fairly rare.
  • Tattoos are permanent!!!

Piercings

Procedural information regarding your piercing:

  • A person may not perform a body piercing on a minor without the written notarized consent of the minor’s parent of legal guardian. An establishment may not perform a body piercing on a minor under the age of 16 unless a parent or legal guardian accompanies the minor.
  • The area to be pierced will be inspected for rash or openings.
  • If area to be pierced is clear of rash or openings it will then be cleaned with iodine and alcohol.
  • Piercing will be preformed using aseptic techniques.
  • All tools used during the procedure have been sterilized by an autoclave.
  • Upon completion of piercing all used supplies will be disposed of in accordance with Florida’s bio medical waste code.
  • All tools used will be cleaned and re-sterilized.
  • Precautions to be taken are eat prior to procedure to maintain proper blood sugar levels, use sun block, as we cannot perform procedures on burned skin, and remove all make-up and hair (shave) prior to procedure.

I have been informed of the procedure and understand the consequences of the procedure which may include swelling, signs / symptoms of infection, irritation, pain, scarring / deformity, or allergic reaction.

05 Identification & Signatures

By submitting this record, you confirm that the information provided is complete and accurate to the best of your knowledge.