[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-307228-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-307228-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","body-art-consent-and-health-disclosure-form-tattooing-and-piercing","BODY ART CONSENT AND HEALTH DISCLOSURE FORM - Tattooing and Piercing","","BODY ART CONSENT AND HEALTH DISCLOSURE FORM collects client identity and emergency contact details, identifies the type of tattooing or piercing procedure, and records key medical and allergy history. The client acknowledges tattoo permanence and scarring risk, confirms legal age or requires a parent/guardian for underage piercing, and agrees not to proceed under alcohol or drug influence. The form covers infection symptoms, medical attention obligations, aftercare compliance, HIPAA information handling, and signature confirmation of understanding and voluntary consent.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/body-art-consent-and-health-disclosure-form-tattooing-and-piercing/307228/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/body-art-consent-and-health-disclosure-form-tattooing-and-piercing/307228.png","ImageObject",442,249,{"name":42,"@type":43},"Bintang","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-25","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",15,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What does the client consent to in this form?","Question",{"text":63,"@type":64},"The client confirms understanding of tattoo and piercing implications, including infection and scarring risks, and agrees to follow aftercare instructions. The client also acknowledges medical information handling per HIPAA.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What medical conditions are asked about in the medical history section?",{"text":68,"@type":64},"The form asks the client to circle applicable conditions such as diabetes, hemophilia, skin disease, epilepsy or seizures, fainting, and narcolepsy, plus allergies and medication-related blood clotting issues. It also asks about cardiac valve diseases and other conditions that may affect the outcome.",{"name":70,"@type":61,"acceptedAnswer":71},"What happens if the client has identified health conditions or does not complete/sign the form?",{"text":72,"@type":64},"The technician will not perform the procedure if the client fails to complete or sign the form. The technician may also decline to perform the procedure if the client has any identified health conditions.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},307228,1790183154,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,103,108,112,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":4},962085564381,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","| BODY ART CONSENT AND HEALTH DISCLOSURE FORM for TATTOOING AND PIERCING |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| CLIENT INFO\u003Cbr>Name:  \u003Cbr>Date of Date of\u003Cbr>Procedure:   Birth:   Address:  \u003Cbr>Phone:  \u003Cbr>Email:  \u003Cbr>Emergency\u003Cbr>Contact:   Phone:  \u003Cbr>Type of Identification Provided:\u003Cbr>Driver’s License Passport Tribal ID Card\u003Cbr>Military ID Permanent Resident Card (Green Card)\u003Cbr>Circle the type of body art being performed: |  |  |  |  | INFORMED CONSENT TO RECEIVE BODY ART\u003Cbr>PLEASE READ AND SIGN WHEN YOU ARE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING.\u003Cbr>In consideration of receiving BODY ART from,  \u003Cbr>(Name of Technician)\u003Cbr>The practitioner at  \u003Cbr>(Name of body art establishment)\u003Cbr>(together with its employees and other technicians, the “Establishment”)\u003Cbr>I   confirm the following by initialing (Client’s Name)\u003Cbr>each applicable item below:\u003Cbr>I understand that a tattoo is considered permanent and may only be   removed with a surgical procedure.\u003Cbr>I understand that any effective removal of a tattoo or body piercing   may leave scarring.\u003Cbr>I am the person on the legal ID presented as proof that I am at least 18   years of age.\u003Cbr>I am under the age of 18 years old and have the presence of my parent\u003Cbr>or guardian to receive the body piercing (applicable only to underage   body piercing. N/A if not applicable) .\u003Cbr>I am not under the influence of alcohol or drugs and that I am\u003Cbr>voluntarily submitting myself to receive body art without duress or   coercion.\u003Cbr>I acknowledge the information I provided in the medical questionnaire   is complete and true to the best of my knowledge.\u003Cbr>The body art described or shown on this form is correctly placed to my\u003Cbr>specifications. If applicable, I have also confirmed all spelling and   grammar necessary in the procedure.\u003Cbr>All questions about the body art procedure have been answered to my\u003Cbr>satisfaction, and I have been given written aftercare instructions for the   procedure I am about to receive.\u003Cbr>I understand the restrictions associated with this body art procedure as   explained by the technician.\u003Cbr>I understand that any medical information obtained will be subject to\u003Cbr>the federal Health Insurance Portability and Accountability Act of 1996   (HIPPA) .\u003Cbr>I am aware of the signs and symptoms of infection, including but not limited to, redness, swelling, tenderness of the procedure site, red\u003Cbr>streaks going from the procedure site towards the heart, elevated body   temperature, or purulent draining from the procedure site.\u003Cbr>I understand there is a possibility of getting an infection as a result of   receiving body art.\u003Cbr>I will seek professional medical attention if signs and symptoms of   infection occur.\u003Cbr>I agree to follow all instructions concerning the care of my body art\u003Cbr>procedure and that any touch-ups needed due to my own negligence   will be done at my own expense.\u003Cbr>I understand that there is a chance that I might feel lightheaded or dizzy   during or after being tattooed.\u003Cbr>I agree to immediately notify the artist in the event I feel lightheaded,   dizzy, and/or faint before, during or after the procedure. |  |  |\n| Tattoo\u003Cbr>Subdermal | Branding\u003Cbr>Microdermal | Piercing\u003Cbr>Tongue Bifurcation | Scarification\u003Cbr>Suspension |  |  |  |  |\n| Procedure Site/Description:\u003Cbr>Technician:   License \\#:  \u003Cbr>MEDICAL HISTORY\u003Cbr>Please circle any conditions listed below that apply to you:\u003Cbr>Diabetes Hemophilia Skin disease (psoriasis, eczema, etc. )\u003Cbr>Skin lesions Skin sensitivity to soap or disinfectant Epilepsy\u003Cbr>Seizures Fainting Narcolepsy\u003Cbr>Additional health information:  \u003Cbr>\u003Cbr>\u003Cbr>How long has it been since you last ate?   |  |  |  |  |  |  |  |\n| Do you have any additional allergies such as to metals, soaps, cosmetics, or alcohol?\u003Cbr>Do you have any condition that requires you to take medications such as anticoagulants that thin the blood or interfere with blood clotting?\u003Cbr>Have you ever been prescr","cbCaigKsLm3ehVXK","https://ap.wps.com/l/cbCaigKsLm3ehVXK","pdf",141539,"English","# Client Info\n## Identification and Procedure Type\n# Informed Consent\n## Medical Information and Infection Awareness\n## Aftercare and Acknowledgements\n# Medical History\n## Conditions and Allergies\n# Signatures","[{\"question\":\"What does the client consent to in this form?\",\"answer\":\"The client confirms understanding of tattoo and piercing implications, including infection and scarring risks, and agrees to follow aftercare instructions. The client also acknowledges medical information handling per HIPAA.\"},{\"question\":\"What medical conditions are asked about in the medical history section?\",\"answer\":\"The form asks the client to circle applicable conditions such as diabetes, hemophilia, skin disease, epilepsy or seizures, fainting, and narcolepsy, plus allergies and medication-related blood clotting issues. It also asks about cardiac valve diseases and other conditions that may affect the outcome.\"},{\"question\":\"What happens if the client has identified health conditions or does not complete/sign the form?\",\"answer\":\"The technician will not perform the procedure if the client fails to complete or sign the form. The technician may also decline to perform the procedure if the client has any identified health conditions.\"}]","BODY ART CONSENT AND HEALTH DISCLOSURE FORM - Tattooing and Piercing | PDF",1789846071]