UNITED TATTOO CONSENT FORM

5160 FONTAINE BLVD

FOUNTAIN, COLORADO 80817

www.united-tattoo.com

(719) 698-9004

TATTOO ARTIST:

TATTOO APPOINTMENT DATE:

Month

Day

Year

FIRST NAME

LAST NAME

ADDRESS (leave blank if address on your identification is current)

EMAIL ADDRESS

PHONE

BODY LOCATION/ AREA OF TATTOO:

TATTOO DESCRIPTION:

CHECK ANY CONDITIONS LISTED BELOW THAT APPLY TO YOU:

CHECK ANY ALLERGIES OR ADVERSE REACTIONS THAT APPLY TO YOU:

ANY ALLERGIES, MEDICATIONS, OR INFECTIONS THAT COULD AFFECT THE HEALING PROCESS?

LET'S GET STARTED!