Release Form

Standard Release Form

This release form ensures that all clients are fully informed of the tattoo procedure, associated risks, and aftercare responsibilities. By completing the form, you confirm your legal eligibility to receive a tattoo, acknowledge the permanent nature of the procedure, and provide necessary information for your safety and satisfaction. Additionally, this form includes an optional section for preferred names, pronouns, and social media tagging, ensuring an inclusive and personalized experience. Your cooperation helps us maintain compliance with Oregon Health Authority regulations while providing the highest quality service.

"*" indicates required fields

Your Info

Legal Name*

(First and Last Name as on your ID)

First Last

Preferred Name/Nickname

If you would like us to address you by a name other than your legal name.

First

Pronouns

Your Phone*

Your Email Address*

Email Address Confirm Email Address

Your Address*

Street Address Address Line 2 City State ZIP Code

Your Appointment

Date of appointment*

Time of Appointment*

Placement on body*

Tattoo Description*

Select Your Artist*

Please select your artist from the dropdown menu. This helps us ensure your release form is correctly assigned to the right artist.

Guest Artist Name:

Waive and Release

Student Procedure*

The artist you have requested is a Student Tattoo Artist, your procedure would be going toward their state required technical procedures.

I agree

Waive and Release*

INFORMED CONSENT: I confirm that I have been fully informed of the inherent risks of receiving a tattoo. These include, but are not limited to, the risk of infection, scarring, allergic reactions to pigments or aftercare products, and potential variations in design. Having been informed, I voluntarily agree to proceed with the tattoo procedure and assume all associated risks.

WAIVER OF LIABILITY: I waive and release Anatomy Tattoo, its artists, students, and staff to the fullest extent permitted by law from any claims or causes of action for personal injury, including but not limited to risks resulting from the tattoo procedure.

AFTERCARE RESPONSIBILITY: I confirm that I have received aftercare instructions and understand my role in caring for the tattoo to prevent infection and ensure proper healing. If touch-up work is required due to my negligence, I agree to cover the cost.

VARIATIONS: I understand that Tattoos are a permanent alteration to my skin and may only be removed through costly and potentially disfiguring means. Variations in design and color may occur, and tattoos will naturally fade over time due to sun exposure and pigment dispersion.

CORRECTNESS: I take full responsibility for the meaning and accuracy of the text or design I provide or select.

LEGAL AGE: I confirm that I am at least 18 years old, have provided valid photo identification, and understand that parental consent does not apply to tattooing in Oregon.

HEALTH DECLARATION: I declare that I am not under the influence of drugs or alcohol. I am not pregnant or nursing. I do not have medical conditions (e.g., diabetes, epilepsy, hemophilia) or take medications (e.g., blood thinners) that may interfere with the tattoo or its healing process. If I have any medical concerns, I have consulted a physician prior to proceeding.

Health Continued

Please let us know if there's anything that may impact your healing such as being diabetic or taking blood-thinning medication.

Instagram Handle

If you'd like us to tag you in instagram photos

Acknowledgment

By signing below, I confirm that I have read and understand this document, including any conditional agreements, and I agree to its terms.

Submit a photo of your ID*

Max. file size: 300 MB.

Type your name here to sign this document*

Phone

This field is for validation purposes and should be left unchanged.