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The following form is meant to gather all necessary information from the client in order to proceed with the requested procedure.

All instruments that either enter the skin or come into close contact with bodily fluids are disposable and are safely disposed of immediately after use, strictly adhering to BodySafe & Toronto Public Health Code.

Please read thoroughly and initial each section to confirm you have understood the information provided. Please ask any questions you may have prior to signing.

PAIN: Although every attempt at reducing pain through topical anesthetic is made, some individuals still may experience some discomfort during the course of the procedure. I understand I may experience some pain and will let my artist know if it happens to become unbearable, though it is generally much less painful than tweezing.

I Agree

 

ANESTHETICS/ALLERGIES: Topical anesthetics are used to numb the tattooed area. Most agents used are Lidocaine/Tetracaine/Benzocaine/Epinephrine/Prilocaine – any known allergy to any of these has been made very clear to the artist. Although extremely rare, an unknown allergy to numbing agents/pigments is possible, therefore you have the choice to take an allergy patch test now: TAKE________ or WAIVE ________ (appt will be rescheduled to at least 24hrs after test)

I Agree

SWELLING/BRUISING: I understand some swelling and bruising may appear for a few days following the procedure. This is common and normal; the severity depends on the individual and usually dissipates within a week. Ice packs can help to reduce swelling in the area.

I Agree

 

UNEVEN  COLOUR/SHAPE: I understand the following procedure is a two-step process – the follow-up appointment (included, at 6-8wks) is meant to address any possible uneven shape, colours, and/or to add more density if desired. Pigment retention issues (which are very dependent on skin-type and aftercare) are addressed as well.

I Agree

 

AFTERCARE: instructions have been clearly explained to me and I have asked any and all questions beforehand or will email if any additional concerns arise. I understand proper aftercare is essential to the final outcome of my procedure and will follow it closely. I am aware infection is always possible with any procedure where the skin barrier is broken and agree to properly care for the skin to avoid such complications.

I Agree

 

PHOTO: I hereby allow the use of my before and after photos to be used for media purposes and release said images to my artist, and New Tribe Tattoo & Piercing.

I Agree

First Client Name

First Name*

Middle Name

Last Name*

Phone*
First Client Date of Birth*
First Client Signature*
Second Client Name

First Name*

Middle Name

Last Name*
Second Client Date of Birth*
Third Client Name

First Name*

Middle Name

Last Name*
Third Client Date of Birth*
Fourth Client Name

First Name*

Middle Name

Last Name*
Fourth Client Date of Birth*
Fifth Client Name

First Name*

Middle Name

Last Name*
Fifth Client Date of Birth*
Sixth Client Name

First Name*

Middle Name

Last Name*
Sixth Client Date of Birth*
Seventh Client Name

First Name*

Middle Name

Last Name*
Seventh Client Date of Birth*
Eighth Client Name

First Name*

Middle Name

Last Name*
Eighth Client Date of Birth*
Ninth Client Name

First Name*

Middle Name

Last Name*
Ninth Client Date of Birth*
Tenth Client Name

First Name*

Middle Name

Last Name*
Tenth Client Date of Birth*
Client 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 or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

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


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