OSCO
Tattoo Consent and Release Form
First Name
Last Name
Email
*
Alternative Email
Phone
*
Additional Phone Number
Telephone Number
Date of birth
Address
City
Country
Country
Which artist are you getting tattooed by?
Referred by:
Do you have Flu like symptoms? (Please notify a member of staff immediately if you answer "Yes.")
Yes
No
Medical conditions (Please tick all that apply.)
Eczema, Psoriasis, Acne or other skin condition - (more prone to skin infections)
Heart Disorders - (more prone to serious heart conditions from any blood infections)
High/Low Blood Pressure - (can cause light headedness)
Haemophilia and other blood disorders - (may result in poor clotting/healing)
Epilepsy or other form of seizures - (medication may cause side effects and may result in fitting during treatment)
Diabetes - (can reduce healing properties of the skin resulting in infection)
Hepatitis - (can pose a risk for operator)
Allergies - (may result in serious skin reaction present in products; ink/latex)
Pregnant - (immune response affected by pregnancy and infection may affect the unborn child; we can't tattoo you if you are pregnant)
Nursing - (risk of infection can be a risk to the baby)
Medication - (side effects may affect healing and recovery from treatment)
Autoimmune Disease or treatment causing it e.g. cancer treatment - (more prone to serious infection, a risk for operator)
Recipient of an organ/bone marrow transplant - (if so you have taken the preventative antibiotics)
None of the above
Any other medical conditions not listed - please give details below.
Confirmation
I confirm that I have been fully informed of the inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to; infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed if the potential risks, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks.
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