You are hereby notified of the possible risks and dangers associated with receiving a tattoo, body piercing, or Dermal anchor. These risks and dangers include, but are not limited to:
1. The possibility of discomfort or pain;
2. The possibility of scaring;
3. The possibility of bleeding;
4. The possibility of swelling;
5. The risk of infection;
6. The possibility of nerve damage; and
7.The increased risk for adolescents during certain stages of developement (body piercing)
NO PERSON MAY RECEIVE A TATTOO, BODY PIERCING OR DERMAL ANCHOR WHO APPEARS TO BE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS.
I am not pregnant or nursing. I do not have epilepsy or hemophilia. I do not suffer from any heart conditions or take medicine that thins my blood. I have informed my artist or piercer of any conditions such as diabetes that may hamper my healing post-procedure.
1. If i suffer from Hepatitis,HIV, or any other communicable diseases i have informed my artist or piercer.
2. I do not suffer from any skin diseases such as keloid scarring, hypertrophic scarring, psoriasis, sun burn, eczema or any other condition at the site of the procedure.
3.I have informed my artist or piercer if i have known allergies to metals, latex, soaps, medications or tattoo pigments. I acknowledge that it is not reasonably possible for my piercer or artist to determine if i will have an allergic reaction from any part or process of the procedure.
4. I have truthfully represented that i am over 18 years of age, and have provided sufficient proof of identification. In the case of a minor piercing i have parental consent and have provided sufficient documentation. (see back)
5. I am not under the influence of alcohol or drugs. I am of sound mind and the decision to receive this tattoo, body piercing, dermal anchor / removal is my decision.
6. I understand the procedure will cause a permanent change to my appearance.
7. I understand there has been no representation of the ability that my skin can be restored tp pre- procedure condition.
8. I understand that infection is always a possibility from obtaining a tattoo, body piercing, or dermal anchor particularly in the event that i do not take proper care of my tattoo, body piercing or dermal anchor and /removal. I agree to the following aftercare instruction that is provided for me.
9. I understand Platinum Ink will not be held liable for medical expenses that may become associated with the procedure.
10. I understand there may be variations in color and design between any tattoo selected by me and as ultimately applied to my body. I understand if my skin color is darker, colors may not appear as bright.
11. FAINTING IS ALWAYS A POSSIBILITY PLEASE NOTIFY YOUR ARTIST OR PIERCER IF YOU HAVE A HISTORY OF FAINTING. Platinum Ink is not responsible for any injuries as a result of fainting.
12. I understand a dermal anchor is semi- permanent and requires professional removal.
13. If i give my consent to a photograph I consent to use of said photograph in portfolios and advertisements.
14. I understand my procedure will be done using sterile instruments.
15. ALL DEPOSITS ARE NON REFUNDABLE.
Parental Consent for Minor Piercing
1. Under penalty of perjury, I, the undersigned, declare the minor receiving a body piercing is my minor child.
2. I have the authority to consent to the body piercing of my child.
3. I have presented identification of myself and my minor child to the manager/artist/piercer of Platinum Ink.
4. At the request of Platinum Ink I have presented any other material demonstrating the status of parenthood or guardianship.
5. I agree to remain present with my minor child during the entire body piercing procedure.