Consent form

Please complete this mandatory form in advance or complete it on site before the session.

Name

Last Name

E-mail

Birth date

Phone number

Do you take blood thinners, anticoagulants, or medications that weaken your immune system?

Yes

Do you have any skin condition in the area to be tattooed that could interfere with the tattooing process, such as (but not limited to): eczema, psoriasis, acne, freckles, moles, sunburn, recent scar, or any other skin disorder?

Yes

Do you have any of the following medical conditions: diabetes, heart disease, seizures, blood disorders, hemophilia, or any other health issue?

Yes

If you have answered YES to any of the questions above, please consult your doctor or healthcare professional to ensure that it is safe for you to receive a tattoo. Thank you for your cooperation.

I hereby certify that..

I certify that I am over 18 years old (ID required).
At the time of the tattoo, I am not under the influence of drugs or alcohol.
I am not pregnant and I am not breastfeeding.
I understand that there is a risk of an allergic reaction and that there is no way for the artist to check if I am allergic to the ingredients of the ink used.
I understand that if there is any doubt about my skin or medical condition, I may request written consent from my doctor to perform the tattoo.
I also understand that I am required to reschedule my appointment in the event of illness, and I agree to wear a procedure mask if I present with obvious symptoms of respiratory virus or any other viral infection.
I fully acknowledge that following tattoo aftercare procedures is my responsibility, and I am aware that failure to follow these procedures could result in the risk of infection. I agree to carefully follow all post-tattoo instructions provided by Atelier Noir et Or in order to minimize any potential danger to my health.
If retouching or several sessions are necessary, I agree to the same conditions and undertake to inform the artist of any change in my state of health.
I hereby declare that I fully release Marie-Claude Décarie-Amiot from any liability, including, but not limited to, any liability related to undesirable repercussions, complications, infections, allergic reactions, or any other side effects that may occur following the tattoo.

Signed on the

Your signature

THANKS! We have received your form.