DermalGrafix Tattoo Medical History Consent and Release Form

DermalGrafix Tattoo

Medical History
Consent and Release Form

  • I hereby certify to the best of my knowledge this information is correct.
  • All questions have been answered to my satisfaction.
  • I understand that the said TATTOO is PERMANENT.
  • This is to certify that I am at least 18 YEARS OF AGE.
  • I am not under the influence of ALCOHOL or DRUGS.
  • I understand there is a possibility of an allergic reaction.
  • I am of sound mind and body and I am choosing to get a tattoo under my own free will.
  • I agree to follow all instructions concerning the aftercare of my TATTOO.
  • I understand there is a chance I might feel lightheaded, dizzy and/or faint due to my decision to receive a TATTOO.
  • I agree to immediately notify the artist in the event I feel lightheaded, dizzy and / or faint before, during or after the procedure. Failure to do so releases DermalGrafix Tattoo and ARTISTS of ALL RESPONSIBILITY.
  • I understand that artists at DermalGrafix Tattoo are independent contractors and responsible for their own work and is not the responsibility of other artists for complete said work, unless agreed to by all parties.
  • I hereby release DermalGrafix Tattoo and ARTISTS of ALL RESPONSIBILITY for the said TATTOO.

Thank you for your business and hope to see you back here again soon!

Who will be participating?

Adult  Children

Signee Information


By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.