BOLD MOVES TATTOOCONSENT FORM MEDICAL CONDITION * Eczema, Psoriasis, Acne, Cellulitis or other skin conditions Heart Disorders High/Low Blood Pressure Haemophilia or other bleeding disorders Epilepsy or other forms of seizures Diabetes Hepatitis Autoimmune disease or treatments causing it Allergies Pregnancy or nursing mother NONE OTHER CONDITION NOT LISTED NAME * First Name Last Name EMAIL * PHONE (###) ### #### ADDRESS Address 1 Address 2 City State/Province Zip/Postal Code Country ARTIST Rich Other DATE MM DD YYYY INDIVIDUAL CONSENT * I acknowledge that I have been given the full opportunity to ask any questions which I might have about obtaining a tattoo and that all of my questions have been answered to my satisfaction. I acknowledge that it is not reasonably possible to determine wether I might have an allergic reaction to the products used during the tattoo session and I agree to accept that such risk is possible I acknowledge that there may be a risk associated with the ink products during tattooing and that such inks may contain substances which are potentially harmful to my health. I understand that discrepancies in colour between the design and the final tattoo can occur due to skin types and aftercare of the tattoo. I declare that I give my full consent to the tattoo being carried out by the aforementioned operator. I also confirm that potential complications, e.g. infection and swelling for the procedure undertaken are always possible, particularly in the event that I do not take proper care of my tattoo. I confirm that the aftercare instructions have been explained to me and that it is my responsibility to follow the aftercare instructions until the site of the tattoo is fully healed. I confirm that the above information provided for me for this consent form is correct to the best of my knowledge, that I am over 18 years of age and that I am not currently under the influence of drugs or alcohol. I UNDERSTAND Thank you!
