To Induce:
e.g. person getting tattoo

Proof of Identity

Attach Image of Current Drivers Licence:
Max file size 5MB
Allowable formats: (.png), (.jpg) & (.gif)

Appointment Details

Appointment Date:
e.g. day/month/year

Appointment Time In:

Appointment Time Out:

Tattoo Price:

GST:
'Effective as of 01/07/2018'

Liability

Do you take all responsibility for the Tattoo procedure and all aftercare?
e.g. Yes or No

Client Details

Age:

Date of Birth:
e.g. Date - Month - Year

First Name:

Last Name:

Email:

Phone:

Street Address:

Suburb:

State:

Postcode:

Parental Consent - Required if Under 18 years old.

Parent/Guardian Name:

Please write in own words the consent you give:

Please Answer The Following Questions So That We May Better Serve You

Do you release all rights to any photographs / videos taken of the tattoo/s?
e.g. Yes or No

Did you supply numbing cream to be applied for your appointment?
e.g. Yes or No

Have you eaten within the last 4 hours?
e.g. Yes or No

Have you had any alcoholic beverages in the last 8 hours?
e.g. Yes or No

Are you prone to fainting?
e.g. Yes or No

Are you prone to heavy bleeding?
e.g. Yes or No

Do you have to take antibiotics before seeing the dentist?
e.g. Yes or No

Have you taken aspirin, ibuprofen, or blood thinners in the last 24hrs?
e.g. Yes or No

Do you have a latex allergy?
e.g. Yes or No

Are you pregnant or breast feeding?
e.g. Yes or No

Do you have any other conditions which might affect the healing of this Tattoo?
e.g. Yes or No

Are you allergic to Non-Toxic Pigments, Distilled water, Alcohol, Witch Hazel, Glycol, Isopropyl, Proprietary?
e.g. Yes or No

Do you have any other allergies?
*if 'YES' specify

Tattoo Details

Write a Description of the Tattoo/s:

Where is the Tattoo being placed on body?

Satisfaction

Is the Artwork/s Look, Appearance, Size & Colour/s Correct?
e.g. Yes or No

Was the Tattoo stencil placed in correct position?
e.g. Yes or No

Was the Tattoo correctly applied?
e.g. Yes or No

Did you receive aftercare cream and advised on proper aftercare instructions?
e.g. Yes or No

Are you satisfied with the result of your Tattoo?
e.g. Yes or No



Feedback

In your own words leave
feedback on Store Hygiene,
Quality of work and
Tattooist Personality?

Signature

Do you agree that all information you have input above is correct and true?
e.g. Yes or No

To complete form please sign/type below your entire name then hit 'Submit Form' located below.