Name *

First Name

Last Name

DATE OF BIRTH *

MM

DD

YYYY

I am 18 years of age *

yes

no

I understand that I will be tattooed using the proper Insturments and techniques. *

yes

no

To ensure proper healing of my tattoo,I agree to follow the aftercare guidelines provided both vocally and online at www.beehaven.ink until healing I complete *

yes

no

I agree to Immediately inform my artist of and concerns or issues that may have arisen from or be related to the tattoo procedure and will seek advice of the staff and follow suggestions given. *

yes

no

I have made the decision to have this procedure done without coercion or duress. *

yes

no

I have a full understanding of the possible complications from this procedure such as, but not limited to; Infection, allergic reaction, scarring or rejection of the tattoo. *

yes

no

I agree that any occurring problems, including infection, due to my own negligence will be my responsibility. *

yes

no

I understand that by having this tattoo performed, I am making permanent changes to my body and no claims have been made regarding the ability to undo the changes made. *

yes

no

I understand that I should eat within two hours before and after my tattoo. *

yes

no

Are you pregnant or nursing? *

yes

no

Are you prone to fainting or light headedness? *

yes

no

I understand that I am not to consume drugs (unless prescription) or alcohol within 24 hours of my tattoo. *

yes

no

Are there any medical conditions that we should be aware of that may affect the tattoo procedure or healing, such as; diabetes, hemophilia, heart conditions, previous staff infection, Eczema, psoriasis. (or any other conditions that are of possible concern). *

yes

no

Do you have sensitive skin or Adhesive allergies? *

yes

no

I understand that I am to follow proper aftercare procedures, and if these procedures are NOT followed, I waive my right to a reduced rate touch up fee ($40/session). *

(THIS REDUCED TOUCH UP FEE IS ONLY AVAILABLE FOR ONE YEAR FROM THE LAST SESSION ON THAT SPECIFIC TATTOO)

yes

no

I understand that my tattoo may be photographed and displayed on line for my artists portfolio, social media or otherwise promotional material. *

(If you prefer your artist not to display the photos, you are also agreeing to discuss that with them at the time of the tattoo)

yes

no

I have seen and approve the tattoo design, spelling (if applicable) and placement discussed. *

yes

no

I DO NOT have any medical conditions that may put the artist at physical risk such as but not limited to; Hepatitis, HIV, AIDS, Tuberculosis, or any other blood borne or mucosal transmitted disease or infection. *

yes I do have a medical concern such as those stated above

no I do not have any medical concerns such as those stated above

Todays date: *

MM

DD

YYYY