Liz Minelli Tattoo

This consent form is for customers with an existing booking

Consent Form

Tattoo Body Part *

First Name *Legal Name

Last Name *Legal Name

Also know as

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Is this your first tattoo? *YesNo

Are you over 18? *YesNo

ID Type *

ID Number *

Client Medical History

Do you currently suffer from, or have you ever suffered from any of the following?

Do you have the capacity to make your own informed decisions? *

Heart Condition/Angina: *YesNo

Blood Pressure Problems: *YesNo

Epilepsy/Seizures: *YesNo

Haemophilia/Blood Clotting Disorders: *YesNo

Blood borne Virus, e.g. Hepatitis B/C or HIV: *YesNo

Skin Complaints, e.g. psoriasis, eczema, dermatitis: *YesNo

Diabetes: *YesNo

Allergic Response, e.g. anaesthetics, jewellery: *YesNo

Are you prone to fainting attacks? *YesNo

Do you regularly take any blood-thinning medicines, e.g. aspirin? *YesNo

Do you take any regularly prescribed medication? *YesNo

Specify the medication *

Are you, or could you be pregnant? *YesNo

Are you breast feeding? *YesNo

Are you Vegan? *YesNo

Have you had the recent onset of a new continuous cough? *YesNo

Do you have a high temperature? *YesNo

Have you noticed a loss of, or change in, normal sense of taste or smell? *YesNo

Have you experienced any Covid-19 related symptoms in the past 5 days? *YesNo

CONSENT TO APPLICATION OF TATTOO AND GENERAL RELEASE OF ALL CLAIMS

I acknowledge by signing this consent and release form that to induce Luiza Tavares de Queiroz, as known as Liz Minelli (Liz Minelli Tattoo LTD) to facilitate a tattoo procedure on my (placement on body) {text-3}, and that I hereby release Liz Minelli Tattoo LTD and its employees and agents from all manners of liabilities, claims, actions and demands in law or in equity, past, present or future.

I understand my procedure will be performed using appropriate instruments and techniques.
I agree to follow the aftercare provided until healing is complete.

I acknowledge that I am old enough to request this procedure and that if this statement is knowingly false, I and my legal guardians may be subject to prosecution in a civil suit for monetary compensation and damages by Liz Minelli Tattoo LTD, its owners, agents and employees.

I release my artist of choice Luiza Tavares de Queiroz, as known as Liz Minelli from responsibility over issues of artists interpretation of design, location, placement, quality of workmanship, spelling, colour, scheme, shading or size.

I acknowledge that all of my questions have been answered to my full satisfaction, and that I induce Liz Minelli to perform this procedure at my own risk.

I confirm that I have eaten in the last eight hours and am not under the influence of alcohol or drugs and am over 18 years of age.
I understand and accept conditions arising with the tattoo. Said conditions may include, but are not limited to scarring, scabbing, hazing, colour bleeding, colour fading, colour falling out, allergic reactions and infection.

After the client leaves the premises, it is the responsibility of the client and not of Liz Minelli Tattoo LTD, its owners, agents or employees.

Signature *

Start signing your signature here

I consent to film and take pictures for social media? *

Consent *

I agree that it is my responsibility to read this and follow the aftercare advice given until the treatment area is healed. I give consent to the operator to retain the details provided on this form for a minimum period of two years from today, according to the privacy policy and terms and conditions.

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This consent form is for customers with an existing booking