CONSENT FORM

First Name *

Please read this page carefully and fill out the form to proceed with your tattoo procedure.

1. If I have any condition that might affect the healing of this tattoo, piercing, or microbladed brows I will advise my artist. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.

2. I do not have a medical or skin condition such as but not limited to: acne, scarring, eczema, psoriasis, freckles, moles, or sunburn in the procedure area that may interfere with said tattoo. If I have any type of infection or rash ANYWHERE on my body, I will advise my artist.

3. I acknowledge it is not reasonably possible to the representatives and employees of "Made Grey Tattoo" to determine whether I might have an allergic reaction to the pigments or processes used in my procedure, and I agree to accept the risk that such a reaction is possible.

4. I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.

5. I realize that variations in color and design may exist between any tattoo as selected by me and is ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.

6. I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo.

7. I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo done.

8. I acknowledge that I am aware of these signs and symptoms of infection which include but aren’t limited to: redness, swelling, tenderness of the procedure site, red streaks going from the procedure site towards the heart, elevated body temperature, or purulent drainage from the procedure site. *These signs and symptoms indicate the need to seek medical care.

10. I am aware that the inks used in this procudure are not FDA approved.

9. l acknowledge that I am not pregnant nor maybe pregnant.

11. I acknowledge I am over the age of eighteen and that I have truthfully represented to my artist that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of the representatives and employees "Made Grey Tattoo” reasonably necessary to perform this procedure.

Please fill out the form below and check the box to consent to the procedure.

Last Name *

Date of birth *

Email *

Phone *

Address *

City *

State *

Postal code *

Upload photos of your ID/Driver's License (Front and Back)

Upload clear photos that show all of the info. front and back including your ID photo.

Do you have any allergies such as metals, soaps, cosmetics, alcohol? If yes, explain in notes section.

Do you use any medications that might affect the healing of the body art you wish to receive? If yes, explain in notes section.

Do you have any other medical or skin conditions that may affect the outcome of your procedure? If yes, explain in notes section.

Have you ever been prescribed antibiotics PRIOR to dental or surgical procedures?

Do you have any cardiac valve disease?

Please list any important notes we should know.

E-Sign

I confirm that all information I have provided is complete and true to the best of my knowledge.

Consent to tattoo procedure

I acknowledge by checking this box I agree that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. I specifically acknowledge i have been advised of the facts and matters set forth on this page, and I willingly agree to them and consent to the application of this tattoo procedure.

Date