Tattoo Consent Form

JINDHAMMA

TATTOO CONSENT FORM

Please read each section carefully and complete all required fields and confirmations. Ask any questions before signing.

1. CLIENT INFORMATION

Full Legal Name

Date of Birth

Month

Day

Year

Age

Street Address

City, State, and ZIP Code

Phone Number

2. Government-Issued Photo Identification

Identification Type

Driver’s License

State ID

Passport

Other

If Other, please specify

Issuing State or Country

ID Expiration Date

A valid, unexpired government-issued photo ID must be presented and verified in person before tattooing begins.

3. Tattoo Information

Tattoo Design or Description

Placement on the Body

Approximate Size

Date of Tattoo Procedure

Procedure: Tattooing

Ink Color: Black

Tattoo Artist: Sasin Jindhamma

Studio: JINDHAMMA

Studio Location: 3202 132nd St SE, Suite 16, Mill Creek, WA 98012

4. Age, Capacity, and Voluntary Consent

I confirm that I am at least 18 years old and will present valid, unexpired government-issued photo identification before tattooing begins.
I understand that I must not be under the influence of alcohol, recreational drugs, or any substance that may impair my judgment or ability to provide informed consent.
I am alert, able to understand this form, and voluntarily choosing to receive a tattoo without pressure, duress, or coercion.
I understand that I may withdraw my consent before tattooing begins and may ask to pause or stop the procedure at any time.

Confirmation

I confirm that the statements above are accurate and that my consent is voluntary.

5. Consumer Health Data Notice and Consent

For tattoo safety, JINDHAMMA collects and reviews the consumer health information you provide.

This may include:

Medical conditions relevant to tattoo safety
Skin conditions
Medications or supplements
Allergies or sensitivities
Adhesive, skincare, or product reactions
History of raised scarring or keloids
Current illness, infection, or symptoms
Pregnancy or breastfeeding status
Information relating to skin readiness, tattoo eligibility, or healing
Tattoo placement, completion, healing, or touch-up photographs
Other health or safety information you voluntarily provide

JINDHAMMA may use this information to:

Evaluate tattoo safety and skin readiness
Determine whether the procedure should be postponed
Determine whether consultation with your healthcare provider may be appropriate
Identify allergies or sensitivities relevant to pigments, bandages, adhesives, or aftercare
Select an appropriate bandage or aftercare method
Respond to health or safety concerns
Document tattoo placement, completion, healing, or touch-up evaluation
Maintain required client and consent records

Consumer health information may be processed on JINDHAMMA’s behalf by service providers reasonably necessary to operate its forms, communications, and secure records. These may include:

Website hosting and form providers, including Wix
Email and communication providers
Secure cloud-storage or record-management providers

JINDHAMMA does not sell consumer health data or provide it to third parties for their own advertising or marketing purposes.

Any sharing that legally requires separate consent will be presented separately.

For more information about how consumer health data is handled and how to exercise your privacy rights, review the Consumer Health Data Privacy Policy.

You may withdraw consent from future collection or sharing of consumer health data, where applicable, by contacting ink@jindhamma.com.

Withdrawal does not affect information processed before your withdrawal.

If information reasonably necessary for tattoo safety is unavailable, JINDHAMMA may be unable to evaluate or provide the requested tattoo service.

Consumer Health Data Consent

I affirmatively consent to JINDHAMMA collecting and using the consumer health information I provide for the tattoo-safety and service purposes described above.

6. Health Information

Do you have any medical conditions, skin conditions, allergies, sensitivities, or medications that may affect tattooing or healing?

No — I have no known relevant conditions, allergies, sensitivities, or medications to disclose.

Yes — I will provide the relevant information below.

I’m not sure — I would like to discuss this before proceeding.

Are you currently pregnant or breastfeeding?

Yes

JINDHAMMA does not provide tattoo services during pregnancy or breastfeeding. If you select “Yes,” the procedure will be postponed.

I agree to notify JINDHAMMA if my health, medications, allergies, sensitivities, pregnancy or breastfeeding status, or other relevant information changes before tattooing begins.

I understand that JINDHAMMA may decline or postpone the procedure or recommend consultation with a qualified healthcare provider when a health or safety concern exists.

Health Information Confirmation*

I confirm that the health information I have provided is accurate and complete to the best of my knowledge.

7. Inherent Risks of Tattooing

I understand that tattooing permanently deposits pigment into the skin and involves inherent risks, including:

Pain
Bleeding, swelling, or bruising
Dizziness or fainting
Infection or exposure to bloodborne pathogens
Scarring, including raised scars or keloids
Granulomas, nodules, or other persistent skin reactions
Allergic or sensitivity reactions
Pigment migration or spreading
Uneven or patchy healing
Pigment loss
Temporary or permanent changes in skin texture or pigmentation
Reduced visibility of changes in moles, lesions, or other skin conditions beneath or near tattooed skin
The possible need for medical care
An unsatisfactory cosmetic result

JINDHAMMA follows applicable sanitation and infection-control requirements, but no procedure can be guaranteed to be entirely risk-free.

An allergic or sensitivity reaction may occur immediately or develop later.

Individual results and healing times vary. Skin characteristics, placement, health, lifestyle, and aftercare may affect the outcome.

I have had the opportunity to ask questions about the procedure, its risks, healing, and aftercare. My questions, if any, have been answered to my satisfaction.

Risk Acknowledgment

I understand and voluntarily accept the inherent risks associated with receiving a tattoo.

8. Final Design and Stencil Approval

Before tattooing begins, I will review and approve the final tattoo design and stencil placement in person.

I am responsible for confirming:

Design details
Size
Placement
Orientation
Spelling
Dates
Numbers
Symbols
Stencil position

The stencil position may be adjusted on the appointment day to fit the body and placement area.

One complimentary round of minor design adjustments is included. Significant or additional changes to the approved concept, size, placement, orientation, or scope may require rescheduling or an updated price.

Tattooing will not begin until I have approved the final design and stencil placement.

Design and Stencil Confirmation

I understand that I must approve the final design and stencil placement before tattooing begins.

9. Appearance and Permanence

I understand that the healed tattoo may vary from a reference image, digital design, or stencil because of skin characteristics, placement, healing, and the natural characteristics of the body.

Fine and minimal linework may soften, spread, fade, or heal unevenly over time. Tattoos placed in high-friction or high-movement areas may fade more quickly.

Tattoos naturally change as the skin ages. Sun exposure, lifestyle, skin changes, friction, and aftercare may affect the long-term appearance.

An exact healed result cannot be guaranteed.

I understand that a tattoo is permanent. Removal may be expensive, uncomfortable, require multiple treatments, cause scarring, and may not restore the skin to its original appearance.

Appearance and Permanence Confirmation

I understand and accept the permanent nature and possible appearance changes of the tattoo.

10. Preparation, Aftercare, and Medical Concerns

I have received or had access to JINDHAMMA’s Preparation and Aftercare instructions.

I understand that improper aftercare may contribute to irritation, infection, pigment loss, scarring, delayed healing, or an unsatisfactory healed result.

If I experience signs of infection, a serious allergic reaction, or another medical concern, I will promptly contact a qualified healthcare professional.

I may contact JINDHAMMA with non-medical questions, but I understand that JINDHAMMA does not provide medical diagnosis or treatment.

Preparation and Aftercare Confirmation

I agree to follow JINDHAMMA’s Preparation and Aftercare instructions.

11. Touch-Ups and Refunds

Completed tattoo services are non-refundable except where otherwise required by law.

One complimentary touch-up may be considered after the tattoo has fully healed when requested within 8 weeks of the original appointment.

A complimentary touch-up is limited to minor refinements of the original tattoo. It does not include design changes, additions, expansions, work altered by another artist, improper aftercare, or avoidable damage.

Final eligibility is determined after evaluation of the healed tattoo under JINDHAMMA’s Studio Policies. Not every tattoo requires a touch-up.

Touch-Up and Refund Confirmation

I understand the touch-up eligibility and refund terms described above.

12. Photography Preference

Photography is optional and will not affect your tattoo service.

Tattoo photographs may show the tattoo, surrounding skin, and placement area. When reasonably linkable to you, they may constitute consumer health data and will be handled according to JINDHAMMA’s Consumer Health Data Privacy Policy.

Select One Option

Public Use — I consent to JINDHAMMA photographing my tattoo and using the images on its website, social media, portfolio, and promotional materials. My name, face, or other identifying details will not intentionally be included without my separate permission.

Private Studio Records Only — I consent to JINDHAMMA photographing my tattoo for private studio records only. The images may not be shared publicly.

No Photography — I do not consent to photography.

13. Final Acknowledgment

I have had adequate time to read and understand this form.

I have had the opportunity to ask questions before signing.

I understand that signing this form does not prevent me from seeking medical care or exercising any right available under applicable law.

I have read and agree to JINDHAMMA’s Studio Policies and Terms of Use.

I acknowledge that I have had access to JINDHAMMA’s Privacy Policy and Consumer Health Data Privacy Policy.

I have read and understand this Tattoo Consent Form and voluntarily consent to receiving the tattoo described above.

14. Client Signature

By signing below, I confirm that this signature is mine, whether drawn or typed, and that I agree to the statements and consent selections in this Tattoo Consent Form.

Client Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Printed Full Legal Name

Date Signed