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BLACK HEART TATTOO, EPSOM
Tattoo
Piercing
Tooth Gems
Bookings & Enquiries
Consent Forms
FAQ
THE ABBEY TATTOO, CHERTSEY
Bookings & Enquiries
Tattoo Consent Form
Marc
Davey
Justin
Courtney
TATTOO CONSENT FORM
Before filling out the form below please show the reception team your photo ID.
Please fill this form out ON THE DAY of your appointment
(no earlier)
Date of appointment
*
required
Where on the body?
First name
Pronouns (optional)
Age
Phone
Name of artist
Description of tattoo
Last name
Date of birth
Occupation
Email
Address
Please read the questions below carefully
Do you have any skin conditions? (Select all that apply)
*
Required
No skin conditions
Psoriasis
Eczema
Keloid scarring
Rash
Skin infection
Sunburn
Moles
Other
Do you suffer from any of the following conditions? (Select all that apply)
*
Required
No applicable conditions
Haemophilia
Diabetes
Epilepsy/ Any form of seizures
Hepatitis
HIV / AIDS
Heart condition
Blood pressure problems
Other
Do you have any allergies? (e.g. latex/adhesives/nuts/dye pigments)
*
Required
No
Yes
Are you on any prescribed medication, antibiotics or blood thinning medication (e.g. Aspirin)?
*
Required
No
Yes
Are you prone to fainting?
*
Required
No
Yes
I confirm that I am not under the influence of drugs or alcohol and have had no drugs or alcohol in the last 24 hours.
​I confirm that I am not pregnant or breastfeeding.
​I understand that the representatives and employees of The Abbey Tattoo do not have a way to determine whether I might have an allergic reaction to any elements or pigments used for my tattoo, and agree to accept the risk that such a reaction is possible.
I understand the importance of the daily aftercare procedure, which will be given to me verbally and in writing at the end of my appointment, and that it is my responsibility to follow these aftercare instructions. I understand there are associated risks with tattooing, which include infection, scarring, ink migration, allergic reactions and localised swelling. I acknowledge that caring for the tattoo is my responsibility upon leaving the studio.
I understand that a tattoo is a permanent change to my skin and body and consent to the application of the tattoo.
I agree to release and hold harmless The Abbey Tattoo and its independent contractors and representatives from any and all claims, damages, expenses, liabilities and legal actions arising from or in any way connected to my tattoo.
​​​​​​​​​I allow any photographs/videos taken of my tattoo to be used by the artist and The Abbey Tattoo for media and advertising on their website and social media accounts.
I am aware that by signing this form I am confirming that I have checked the design and am happy with it, and that all spelling/grammar/dates are correct. I accept full responsibility for any errors present in the design, resulting in an error in the tattoo.
I understand that I must be 18 years of age or over to obtain a tattoo. I declare that the information I have provided on this form is correct to the best of my knowledge. I am aware that it is a crime to deliberately falsify any details, and by doing so I may be putting my own health at risk.
Client signature
Clear
Staff signature
Clear
Send
A D D R E S S
8 Windsor Street
Chertsey, KT16 8AS
E M A I L
theabbeytattoo@hotmail.com
H O U R S
Tuesday-Saturday
11:00-18:00
C O N N E C T
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