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Tattoo Waiver

Home

Artist

Contact

Aftercare

Tattoo Waiver

Broken Art Tattoo – Digital Waiver

Please complete this release form. Tap Start to begin.

Client Information

Full Name

Date of Birth

Phone

Address

Artist & Procedure

Artist

Other / Guest Artist

Procedure Type

Procedure Site

Design / Description

ID Verification

Type of ID

Last 4 of ID #

ID Photo (front)

Health & Medical

Diabetes

Hemophilia / bleeding disorders / blood thinners

Pregnant or nursing

Hepatitis or liver disease

HIV / immunocompromised

History of keloids / problem scarring

Allergies (ink/latex/lidocaine/metals/other)

Recent Accutane/antibiotics/steroids

List medications/allergies or other conditions

Disclosures & Consents

I am of legal age or have required authorization.

I am not under the influence of alcohol or drugs.

I understand infection risks and prevention; I received aftercare instructions.

I understand risks including pain, swelling, allergic reaction, scarring, dissatisfaction, and need for touch-ups.

I understand sterile/single-use equipment and aseptic technique are used.

I acknowledge services are not refundable.

Optional Consents

I consent to photos/video of my tattoo for the studio’s portfolio/social media.

I agree to receive appointment reminders and occasional updates by email.

Follow-up

Email me my aftercare instructions and studio links

Signature

Sign inside the box

Thank you!

Thank you for trusting Broken Art Tattoo with your tattoo! Please follow your artist’s aftercare instructions and don’t hesitate to reach out if you have any questions.

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