consent-form - NaviaInk

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consent form

how to prepare
aftercare

Home
consent form

how to prepare
aftercare

Home
Aftercare
Consent form
How to prepare

PLEASE FILL OUT THE BELOW FORM ON THE DAY OF YOUR FIRST APPOINTMENT AT NAVIA INK

You have requested a tattoo that involves minor breakage of the skin surface with a needle and this process may complicate some medical conditions.

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FULL NAME *

Imię

Nazwisko

E-MAIL *

PHONE NUMBER *

MEDICAL CONDITONS (tick if any apply to you)

ECZEMA, PSORIASIS, ACNE, CELLULITIS OR OTHER SKIN CONDITION - more prone to skin infections
HEART DISEASE - more prone to heart complications from blood infections
HIGH/LOW BLOOD PRESSURE - can cause feeling light headed
HAEMOPHILIA OR OTHER BLEEDING DISORDERS - may result in poorclotting/healing
EPILEPSY/SEIZURES - medication can cause side effects and may result in fitting
DIABETES - can reduce healing properties of the skin resulting in infection
HEPATITIS A B OR C - poses a risk to the tattooist
HIV - poses a risk to the tattooist
CANCER/CANCER TREATMENTS- having a reduced autoimmune system risks being more prone to serious infection
ALLERGIES - may result in reaction to ink/ other products
PREGNANT - any infection may affect unborn child
BREAST FEEDING - possible infection is a risk to the baby
ON MEDICATION - side effects may affect healing and recovery from treatment

Please use this space to give us any necessary details about the condition you ticked above (if any)

BY TICKING THE BOXES BELOW I AGREE *

I AM OVER THE AGE OF 18 (ID required)
I HAVE EATEN IN THE LAST 2 HOURS
I HAVE NOT CONSUMED ALCOHOL OR DRUGS IN THE LAST 24HRS

PLACEMENT AND SHORT DESCRIPTION OF A TATTOO

DATE *

I ACKNOWLEDGE THAT I GIVE MY FULL CONSENT TO THE TATTOO PROCEDURE. AS THE PROCEDURE INVOLVES MINOR BREAKAGE OF THE SKIN WITH A NEEDLE, I UNDERSTAND THE HEALTH RISKS AND HAVE COMPLETED THIS FORM TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE *

Your artist will explain your aftercare in full at the end of your appointment, accompanied with a leaflet which will be emailed to the above details. Our team are always on hand to offer full support.