Loading...

INFORMED CONSENT, RELEASE AND WAIVER                                                       
IRON BRUSH TATTOO STUDIO 

226 S. 16th, Lincoln, NE 68508 (402)-474-5151   

♦Agreement for Services and condition: In consideration of the services of Iron Brush Tattoo Studio and all other associated persons or entities (collectively, the “Studio”) I state that I am acting voluntarily, and I fully consent to the application of a tattoo and to any actions or conduct of the Studio reasonably necessary to the procedure. I acknowledge that I have been given the full opportunity to ask questions I might have about the tattoo procedure, to approve of the general design of the tattoo, the risks and the care and treatment of the tattoo. I acknowledge that all my questions have been answered to my full and total satisfaction. The Studio does not recommend any topicals or numbing cream the customer may apply and assumes no responsibility or guarantees for their use. 

♦Other Conditions and Agreements: I have read, understood and accepted the terms and conditions of this Consent and Release and acknowledge that it shall be effective and binding. I agree that the Studio and its artists retain all rights to the image(s) that are tattooed on me. The image may be duplicated, photographed and/or used by the Studio or its artists in advertising, in portfolios, or in publications.    


♦Risk notification: As with any procedure involving needles piercing and thereafter inserting the skin, there are risks involved. Possible risks associated with tattooing include but are not limited to infections, scarring, keloids, granulomas, raised tattoos, ink migration, healing issues, including but not limited to prolonged healing times, and other possible risks to Customer's health. Some individuals can get light headed or pass out during the procedure and there is a risk of falling which can lead to other injuries. Other risks, both known and unknown, exist when a Customer undergoes a tattoo procedure and the Customer assumes all risks, both known and unknown, when he/she consents to undergoing the procedure. Possible allergic risks to the procedure include, but are not limited to allergies to ink, pigments, dyes, gloves, soaps, cleaning products and latex. The pigments used during the procedure can also pose other medical risks to Customer, including but not limited to allergic reactions. Furthermore, the pigments can make it difficult for medical professionals to evaluate the Customer's skin or changes in your skin after the procedure that may pose a risk to you. The Customer understands that the medical risks that may exist as a result of the use of pigments during the procedure are unknown to the Studio but by agreeing to this procedure the Customer assumes any risks associated with the use of pigments during the procedure. Customer further acknowledges and agrees that: (i) this procedure entails numerous medical risks, both known and unknown and the risks and side effects of this procedure can differ for each individual and the Customer both understands and assumes those risks, (ii) the risks include the possibility of injury to me (iii) the Customer understands that the risks which have been discussed with Customer may not be complete and there may be unknown or unanticipated risks, (iv) Customer acknowledges that he/she may experience an allergic reaction(s) to the dyes, pigments or other products, tools or substances used during the procedure, and (v) the inks, pigments, and dyes may contain potentially harmful substances, and (vi) Customer understands and acknowledges that it is not reasonably possible for the Studio to determine or ascertain whether Customers might experience any of the risks or side effects as described herein including, but not limited to an allergic reaction, granulomas, keloids, infection, prolonged healing time, scarring, raised tattoos, ink migration, ink drift, misspellings, permanent bruising or any other risks or damages to Customers health, and (vii) I understand the Customer assumes all responsibility for any outside topicals or numbing cream they may have applied before the tattoo, and (viii) the Customer assumes responsibility for all risks known and unknown.

♦Description of tattoo procedure: Sterile instruments and needles are set up new for each client. New pigments are poured for each client. The area to be tattooed is cleaned and scrubbed and shaved if necessary. A stencil or drawing of the design is placed on the area for client approval. The design is tattooed. Upon completion, the tattoo is washed and dressed, and the artist will discuss the after care (see below) and cleaning of the tattoo. I understand and acknowledge that variations in color and design may exist between any tattoo selected by me and as ultimately applied to my body. Such variations are a normal part of tattooing and the practitioner may determine to make changes as he or she determines to be within keeping of the art. I understand and acknowledge that tattooing is a permanent change to my appearance and that the Studio has not made any representations to me regarding my ability to later change, alter or remove my tattoo.

I state, and understand the Studio will rely upon, the information I have answered in this form.

COVID-19 WAIVER: I understand that I am opting for a service that is not urgent and not medically necessary. I also understand that the coronavirus disease (COVID-19) was declared a worldwide pandemic by the World Health Organization. I further understand COVID-19 is extremely contagious. State and federal health agencies recommend social distancing. I hereby agree to indemnify and hold the Studio harmless and release the Studio from any liability whatsoever should I become infected with COVID-19 which may include but not be limited to claims for personal injury, loss of income, disability, illness and death. Furthermore, I understand that this Agreement is subject to the laws of the State of Nebraska and further agree that the appropriate venue for any dispute involving this Agreement shall be Lancaster County, Nebraska. Given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 if I proceed with this elective service. Accordingly I acknowledge and assume the risk of becoming infected with COVID-19, and any variation of mutation thereof, through this elective service and I gave my express permission for the staff at the Studio to proceed with the same. This consent applies to any follow up of additional services in the upcoming months. I understand that even if I have been tested for COVID-19 and received a negative test result, the tests may not have detected the virus or I may have contracted COVID-19 after the test. I will not hold that business and professional offering the service responsible for any liability related to COVID-19 and variation or mutation thereof. I understand that exposure to COVID-19 before, during, or after my procedure(s) may result in complications and/or delayed healing. I have been given the option to defer my service to a later date. However, I understand all the risks including those noted herein and I would like to proceed with this service. I have been offered a copy of this consent form. I understand the explanation and consent to the procedure(s).

By signing below, I agree to notify my tattooer/piercer immediately if I experience any of the symptoms listed, or test positive for COVID19 in the next 3 days. I understand that the Studio, and its independent contractors, employees, staff and representatives cannot guarantee, with total certainty, that all risk of contracting an illness or virus such as Covid19, has been eliminated.

♦I understand that there are no warranties express or implied of any kind or nature and I waive any right to claim differently. I agree that tattooing is an art form and that the image may be slightly different in terms of color, clarity, size or condition than what I expect.  I waive any general damages as a result of any claim that I might have and agree that my damages, if any, against the Studio for any reason, including, but not limited to medical complications, misspelling or graphic errors shall be limited to the cost of the tattoo and there shall be no other remedy. This agreement shall be governed only by the laws of Nebraska. I made this decision freely and voluntarily and have not relied on any oral, written, or visual representations or statements of the Studio. I agree that the practitioner is an independent contractor and the Studio is not responsible for his/her actions.

I Agree

February 12, 2025


First Clients Name

First Name*

Last Name*

Phone*
First Clients Date of Birth*
First Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
First Clients Signature*
Second Clients Name

First Name*

Last Name*
Second Clients Date of Birth*
Second Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Third Clients Name

First Name*

Last Name*
Third Clients Date of Birth*
Third Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Fourth Clients Name

First Name*

Last Name*
Fourth Clients Date of Birth*
Fourth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Fifth Clients Name

First Name*

Last Name*
Fifth Clients Date of Birth*
Fifth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Sixth Clients Name

First Name*

Last Name*
Sixth Clients Date of Birth*
Sixth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Seventh Clients Name

First Name*

Last Name*
Seventh Clients Date of Birth*
Seventh Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Eighth Clients Name

First Name*

Last Name*
Eighth Clients Date of Birth*
Eighth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Ninth Clients Name

First Name*

Last Name*
Ninth Clients Date of Birth*
Ninth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Tenth Clients Name

First Name*

Last Name*
Tenth Clients Date of Birth*
Tenth Clients Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and event by e-mail.
TATTOO AFTERCARE: Always thoroughly wash your hands with soap and water before touching your tattoo. Initial Aftercare: After 2 hours remove the bandage. Do not re-bandage. Clean thoroughly with soap and water. Let the tattoo air dry for several hours, then apply a thin layer of A&D or lotion. Use a plain unscented lotion: Cetaphil, Curel, Lubriderm. Daily Aftercare: In the shower lightly wash the tattoo and let air dry completely. Apply a very thin layer of A&D or lotion to tattoo once daily. Less is better. Keep your tattoo clean. Don't pick or scratch the tattoo while it is healing, flaking of the skin is normal. Leave it be. Avoid excess rubbing on clothing. Avoid sunlight exposure, tanning, and swimming for 2 weeks. Please call with any questions.
I acknowledge receipt of a copy of this form and that I have been advised of the proper care of my tattoo. I understand and acknowledge that I might experience an infection or other potentially serious conditions as a result of obtaining a tattoo or as a result of not properly caring for the tattoo especially if I do not follow the Studio's instructions on how to properly care for my tattoo. I agree that I will promptly call the Studio with any questions about the condition of my tattoo or seek medical care of any sign of infection or other condition that appears to be related to the tattoo or any other service performed by the Studio.*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

PLEASE ONLY FILL THIS FORM OUT THE DAY OF YOUR TATTOO. Thank you

Consent forms must be filled out the day of the appointment. *

Todays date: *
I am over eighteen (18) years of age and that the ID that I have shown the Studio is true, accurate and not expired. *
Yes
No

ID number (any VALID drivers license, state ID, or any state or government issued ID with a photo and date of birth) *

Gender *
Are you well rested and have you eaten within the last four (4) hours?*
Yes
No
Are you pregnant?*
Yes
No
Are you nursing? *
No
Yes
Are you currently under the influence of any medication, drugs or alcohol?*
Yes
No
Have you consumed anticoagulants including, prescription or over -the-counter (aspirin, ibuprofen, etc.), in the last 24 hours?*
Yes
No
Have you used any topicals or numbing creams in the tattoo area? The Studio does not recommend any topicals or numbing cream and assumes no responsibility or guarantees for their use. *
Yes
No
Have you taken any acne and or skin medications (i.e. Accutane, Isotretinoin, Absorica, Amnesteem, Claravis, Myorisan, Zenatane) within the last six (6) months?*
Yes
No

If yes, what skin medications have you taken?
Do you have diabetes, epilepsy, hemophilia, high blood pressure, heart condition, heart disease, or any other issues that may interfere with the healing of a piercing?*
Yes
No
Do you have any communicable diseases or other conditions?*
Yes
No

Please list any communicable diseases or other conditions
Do you have any history of bleeding disorders, or diseases?*
Yes
No

Please list any history of bleeding disorders, or diseases?
Do you have any medical conditions and known allergies?*
Yes
No

List any medical conditions and known allergies
Do you have any conditions that may affect/hamper healing?*
Yes
No

List any conditions that may affect/hamper healing
Are you sunburned or have a rash or any other skin irritations in the location for the tattoo?*
Yes
No
Do you have any medical contradictions to getting a tattoo? *
Yes
No
Have you ever been told by a medical professional not to get a tattoo for any reason? *
Yes
No
I understand there is greater risks in getting a tattoo, known and unknown if I have medical conditions. *
I understand
I do not agree

Location of tattoo on body: *

Description of tattoo: *

If a tattoo is to be altered or covered, description of the original tattoo:
Which artist is doing your tattoo?*
I understand that all of the services and procedures of the Studio are performed by and independent contractor using only single service equipment (i.e. new needles and pigments for each client).*
Yes
No
Do you give the Studio the irrevocable right to use my picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for portfolios, advertising, publications, or trade, and waive any right to inspect or approve the finished product, including a written copy, that may be created in connection therewith? The picture, portrait, or photograph may be duplicated and/or used by the Studio or its artists in advertising, portfolios, or publications in print or electronic form.*
Yes
No
I would like to request my artist (and I) wear a mask during the tattoo procedure*
No, I do not request my artist wear a mask
yes, I request my artist wear a mask and I will wear one as well
Do you suffer from any physical, mental, or emotional conditions that could cause complications for the tattoo or todays tattoo procedure? *
No
Yes

List conditions that could cause complications for the tattoo or todays tattoo procedure:
HEALTH SCREENER: Please check any of the following in the last 5 days:
Cough or any other symptoms of COVID or other infectious disease?
Fever above normal temperature
Unexplained Rash
Sore throat
Runny nose or congestion
Loss of sense of taste or smell?
Shortness of breath or difficulty breathing
Chills or repeated shaking with chills
Headache
Been tested for COVID or any other infectious disease and are awaiting results?
Been notified that you have been exposed to COVID or any other infectious disease?
Were you or a family member in close contact with a person known to have COVID or any other infectious disease?
Are you living with anyone who is sick or quarantined or have symptoms of COVID or any other infectious disease?
I assume all legal liabilities for not disclosing to the tattoo artist any physical, emotional, or mental conditions that put me or the tattoo artist at risk, including but not limited to blood borne pathogens, hemophilia, or other disease.*
Yes
No
Do you agree and understand that the Studio and the Artists are not medical professionals and cannot diagnose your medical needs or risks, and you assume all risks and liabilities known and unknown for receiving a tattoo. *
No
Yes
Do you acknowledge that you have been given an adequate opportunity to read and understand this document?*
Yes
No
Are you voluntarily getting a tattoo and acting under no undue burden, distress or constraint?*
Yes
No
Have you answered all the questions in this document truthfully and to the best of your ability?Click to customize question*
Yes
No
Do you understand that you are signing a legal contract?*
Yes
No
How did you hear about us?*

Other reason you chose Iron Brush?
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!