Tattoo Consent Form - HANA WOLHF

Consent Form

Wolhf Studio - Tattoos by Hana Wolhf

Studio 13 @ Atlas North East

1st Floor Orbis Community

65 High Street

Gateshead

NE8 2AP

Client Details

First name *

Last name *

Date of Birth *

Phone *

Email *

Address *

Date of appointment *

Medical History

Do you have a communicable disease, such as but not limited to HIV, Hepatitis A, B, & C? *

Yes

Do you have any skin conditions (e.g eczema, impetigo, psoriasis, ketosis pilaris etc)? - YES or NO *

{If yes please identify the condition above}

Have you suffered from the following: Diabetes, heart disease / condition, epilepsy / seizures, blood-related diseases? - YES or NO *

{If yes please identify the condition above}

Please detail any other blood, skin, or health condition that your tattoo artist should know about *

Acknowledgement and Waiver

I understand that this procedure is a permanent change to my skin and body *

I agree

I confirm that I, the above named, give my permission to be tattooed and I am fully aware of the process involved and I understand the importance of the aftercare procedure *

I agree

I understand that I am solely responsible for carrying out and maintaining the hygiene and aftercare of my tattoo and that failure to do so may result in adverse healing *

I agree

I agree 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 agree

I acknowledge that it is not reasonably possible to determine whether I might have an allergic reaction to the elements, ingredients, pigments or the process used in my tattoo and I agree to accept the risk that such is possible. I agree to indemnify and keep indemnified the artist Hana Wolhf against all claims or proceedings in respect of any personal injury or damage arising out of the supply of service *

I agree

I fully understand that I must be over 18 years of age to be tattooed. I acknowledge that I have truthfully represented to the artist Hana Wolhf that I have given my correct name, age, and address on this form *

I agree

I allow my tattoo to be photographed and possibly used for social media and / or other publicity for the artist Hana Wolhf *

Yes

I agree to release and forever discharge Hana Wolhf from any and all claims, damages, and legal actions arising from or connected in any way with my tattoo and the procedures and conduct used to apply my tattoo *

I agree

I understand, read, and completed this questionnare truthfully. I agree that submitting this form constitutes full disclosure and that it supersedes any previous verbal or written discourse. I understand that this document is to provide the best possible client experience when receiving a tattoo from Hana Wolhf at Wolhf Studio *

I agree