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Consent Form

I hereby declare that I give Sergio Canete my full consent to tattoo me and that the information given below is true to the best of my knowledge.

PERSONAL DETAILS

First Name

Last Name

Email

Contact Number

Address

Birthday * required

Age

NEXT OF KIN

Name

Email

Contact Number

Relationship

MEDICAL CONDITION

Do you suffer any of the following:

Heart condition/pacemaker: *

Yes

No

Epilepsy *

Yes

No

Haemophilia *

Yes

No

HIV/Hepatitis *

Yes

No

High/low blood pressure *

Yes

No

Diabetes *

Yes

No

Skin condition (eg. psoriasis) *

Yes

No

Allergies *

Yes

No

Allergies *

Yes

No

Taking blood thinning medication *

Yes

No

PLEASE TICK TO CONFIRM

I have requested this tattoo of my own free will and understand that the artist will be in physical contact with me whilst tattooing

I am over 18 and can produce proof of age

I am not under the influence of drugs or alcohol

I am not pregnant or breastfeeding

I understand no form of anaesthetic will be used in the procedure

If there are any words in the tattoo, I can confirm that I will check that they are spelt correctly

I agree with photos of the tattoo being taken and potentially used on social media

I have been given a price quote and have the means to pay for this

I understand that every care will be taken to ensure that the procedure is carried out in a hygienic way, which includes the use of disposable and pre-sterilised equipment

AFTERCARE

Aftercare is a really important part of your tattoo's healing process. Verbal and written aftercare instructions will be given.

On leaving the studio I understand that the aftercare of my tattoo is my responsibility and I will comply to the artist's instructions regarding this

Signed

Date

serg.mcan.art@gmail.com

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