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BACKSTAGE TATTOO CONSENT FORM

4472 PALISADES CENTER DRIVE WEST NYACK, NY 10994 – 845.727.4909
CONSENT, RELEASE AND WAIVER OF ALL CLAIMS

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I specifically acknowledge that I have been advised of the following:

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I represent to my tattoo artist that

 
 
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The following conditions may increase health risks associated with receiving body art:

  • History of Diabetes
  • History of Hemophilia (bleeding)
  • History of Skin diseases, lesions, or skin sensitivities to soaps, disinfectants etc
  • History of allergies or adverse reactions to pigments, dyes, or other sensitivities
  • History of epilepsy, seizures, fainting, or narcolepsy
  • Use of medications such as anticoagulants, (Coumadin) which thin the blood and/or interfere with blood clotting
  • Hepatitis, HIV or any other communicable disease
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Now that you have gotten your new tattoo, Back Stage would like to thank you for choosing our parlor. It’s up to you now to make sure you properly take care of your tattoo. 

Here are some helpful instructions: 

• 1. Leave the bandage on for a few hours. 

2. Wash with warm water and anti-bacterial soap & pat dry. 

3. Apply a non-petroleum jelly based anti-bacterial cream (H2Ocean, Tattoo Goo) 2 – 5 times a day for 2 weeks. 

For at least 2 weeks: 

1. Do not pick scabs. 

2. Do not submerge in water. 

3. Do not expose to direct sunlight. 

The tattoo may form a layer of dry skin or a light scab in a few days. This will flak off by itself in time. Do not panic… this is normal. If an infection occurs, please consult a physician. 

CONSULT HEALTH CARE PROVIDER FOR:

1. Unexpected redness, tenderness or swelling at the site of the piercing 

2. Rash 

3. Unexpected drainage at or from the site of the piercing 

4. Fever within 24 hours of the piercing

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