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Complete the consent form below prior to your appointment with Debut Studios

First Name

Last Name

Email

Address

Phone

Birthday

Tattoo Description & Placement

Have you ever suffered from any of the following: * Required

Heart disease/Condition

Hepatitis A B or C

Haemophilia / other clotting disorder

HIV

Diabetes

Seizures e.g. Epilespsy

Fainting attacks

Keloid Scarring

Psoriasis

Cellulitis

Acne

Eczema

Allergic reactions e.g. Anaesthetics /Latex/ Adhesive plasters/ Jewellery metals/ Creams/ Iodine/ Shellfish/ Other

Known or previous reaction to dye/pigments

Are you currently pregnant or breastfeeding?

None of the above

Any other relevant information

Please tick each statement below to confirm you have read and agree to each one.

If you have answered yes to any of the above, then you may need to consult a Doctor before proceeding.

I acknowledge that by signing this agreement, I have been given the full opportunity to ask any questions which I may have about obtaining a tattoo and that all my questions have been answered to my satisfaction.

I acknowledge that it is not reasonably possible to determine whether I might have an allergic reaction to the pigments or the process used during my tattoo and I agree to accept the risk that such is possible

I agree to indemnity and keep indemnified the supplier/studio/tattoo artist against all claims or proceedings in respect of any personal injury or damage arising out of, or as a result of, the supply of service.

I accept that there is always a risk of ink falling out or ‘blowing out’ as part of the tattoo process.

I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my tattoo. I agree to follow all instructions concerning proper aftercare of my tattoo as advised.

I understand that I must be 18 years of age or older to be tattooed. I acknowledge that I have truthfully represented myself to the employees of the studio named and that I have today given my correct names, address and age.

I have also comprehensively answered the questions regarding my health to the best of my knowledge and I confirm that I am not currently under the influence of alcohol or drugs.

I consent to photographic and video recording of all or part of my service/treatment. I understand this content may be used for promotional purposes on social media and website. Debut Studios hold exclusive rights to all content.

This is to certify that I, the above named and undersigned, give my permission to be tattooed and that I am fully aware of the process involved and understand the importance of the advised daily aftercare procedure. I confirm I am of age of consent.

Your Signature

Thanks for submitting!

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07940 500296

DEBUT STUDIOS,

36-42 NEW INN YARD,

SHOREDITCH

LONDON, EC2A 3EY

© Debut Studios Tattoo Limited 2023. Website by Soka

VAT Registration No.: 431065727

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