TATTOOING CONSENT FORM

PLEASE COMPLETE ALL SECTIONS OF THIS FORM – we want you to feel safe, comfortable, happy, and taken care of. Please communicate openly with your artist to ensure we know we continue to allow you to feel this way 🙂

For your INFORMATION

There are risks involved in getting a tattoo. These include fainting and redness and swelling to the area.

There are also risks involved in not caring properly for a new tattoo:

Localised infections (such as cellulitis)
Blood infections (sepsis)
Poorly healed tattoos

Your full name(required)

Pronouns (eg she/he/they)(required)

Postal address(required)

Email – this will add you to our mailing list

Phone number(required)

Name of doctors surgery(required)

Emergency contact name and phone number(required)

Date of birth(required)

Body part to be tattooed today?(required)

Who is your tattoo artist today?(required)

What ID did you bring with you today?(required)

We often take photos (and sometimes video) for our social media channels. Do you consent to your image and/or voice being used for these purposes? Please also feel free to include your Instagram @ if you would like to be tagged.(required)

I HAVE eaten a decent meal in the last TWO hours

The following questions relate to your health. Please answer them all, and sign electronically to indicate you have read and understood the information in this form, and grant your consent.

Do you suffer from any heart conditions, eg prosthetic heart valve / heart valve disease / angina / blood pressure problems?

Do you have epilepsy? If so, how is it controlled?

Do you suffer with any condition that affects your immune system, or take any immune-suppressant medication (this includes steroids)?

Do you have diabetes?

In the last 14 days, have you been unwell in any way – eg cold, flu, stomach bug?

Do you suffer from haemophilia or any other blood clotting condition, or take any anticoagulant medication such as Warfarin or high-dose aspirin?

Are you aware of having contracted any blood-borne virus, eg hep B, hep C, hep D, HIV?

Do you have, or have you ever, had any problems with skin healing in the past, eg psoriasis, eczema, or impetigo?

Do you suffer from any known allergic responses, eg plasters, creams, metals, iodine, shellfish, latex, foodstuffs, or anything else? If yes, please be specific. Please include any incident where you have had an allergic reaction to dye pigments or metals.

Do you take any prescribed medication regularly? Please include anything you haven’t already mentioned on this form.

Are you pregnant or breastfeeding?

Are you prone to ‘fainting attacks’ or lightheadedness? If yes, please state reasons/ regularity etc.

Have you ever suffered with any skin infection, eg cellulitis?

Have you ever suffered with any blood infection, eg sepsis?

Any other notes/information we need to know about you?(required)

CLIENT CONSENT /// I declare that I give my full consent to the tattooing being carried out by the aforementioned practitioner. I confirm that potential complications (eg infection and swelling) for the procedure undertaken are possible if I do not take care of my tattoo. A written aftercare advice sheet containing detailed aftercare information has been offered to me and I agree that it is my responsibility to read this and follow the instructions on it, until the tattoo has healed. I confirm that the above information provided by me, on this consent form, is (1) correct to the best of my knowledge, (2) that I am over the age of consent for this procedure (18years or older) and (3) that I am not currently under the influence of alcohol or drugs. /// TYPE YOUR NAME IN THE BOX BELOW TO SIGN YOUR CONSENT(required)

i do not have any symptoms of coronavirus(required)

I agree to call or email Black Moon if I develop any symptoms of covid-19 over the next two weeks

I have not had any covid-19 specific symptoms in the last 14 days(required)

I understand the risks of having a tattoo done during a viral epidemic, as it requires very close contact with another human(required)

i will follow all guidelines from my artist, and local authorities, and national government regarding covid-19(required)

TYPE YOUR NAME TO AGREE TO OUR COVID-19 PROCEDURES(required)

AFTERCARE /// The first three days of the healing process are extremely important! We highly recommend that you purchase our £5 aftercare pack, which will provide you with your first 24 hours of sterile, safe cleaning products. Included in the pack is a complete 14 day guide, enough antibacterial soap for the first 24 hours of cleaning, and some sterile wipes (not recommended for use directly on the tattoo) to ensure your hands are always clean before applying your aftercare.

/// We also recommend purchasing the £5 YAYO aftercare balm ///

Armed with these things, you are in the best possible position to prevent any issues and to ensure your tattoo heals to look as perfect as the day it was applied!

This total £10 purchase is to ensure that you have all the right tools to help keep your tattoo from becoming infected due to poor aftercare habits.

A tattoo is an open wound, we always thoroughly clean your skin with medical grade antiseptic and antibacterial products before, during, and after the tattoo process. Once complete we clean your tattoo again with antibacterial wound wash and apply a sterile dressing to the area. The chances of a foreign object or bacteria being transferred to your tattoo during the application process are practically zero.

Once you leave the shop, the tattoo and the aftercare become your responsibility, and we therefore cannot be held responsible for infections or poorly healed tattoos due to bad aftercare.

Because tattoos are large areas of open skin, there are therefore many things which can cause a tattoo to become infected, most commonly:

• Pet hair, pet dander and their saliva

• Unclean hands being used when applying aftercare to the tattoo

• Someone else accidentally touching the tattoo

• Bacteria on your clothing and bathroom towels or bed sheets

• Picking or scratching your tattoo in your sleep.

Unfortunately infections are a known associated risk of having a tattoo and can simply just happen, no matter how careful we, and you, are.

It is unlikely and unusual but it is a possibility, so we have to make you aware of your responsibility to look after this tattoo, which is identical to a fresh open wound and has been cleaned and dressed properly by your artist at the end of the session.

Of course the decision to purchase these products and follow our advice is up to you, so please indicate with a yes or no below whether you would like to purchase the items mentioned above:

24 hour wound cleaning pack (£5)(required)

Yayo antibacterial aftercare balm (£5)(required)

I am aware of the implications of poor aftercare of a tattoo(required)

I understand that a tattoo is an open wound and it is my responsibility to keep it clean to avoid infections(required)

I understand that Black Moon will do everything possible to ensure my tattoo is clean, free of any bacteria, and wrapped safely in a sterile dressing before I leave(required)

I understand that Black Moon and its artists cannot be held responsible for any infection that could enter my body via the tattoo site(required)

PLEASE TYPE YOUR NAME TO INDICATE YOU HAVE UNDERSTOOD THIS FORM IN ITS ENTIRETY, AND CLICK SUBMIT TO AGREE(required)

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For your INFORMATION

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