BODY ART CONSENT FORM

CLIENT INFO:

Fill in your personal information below.

TREATMENT:

Select your treatment:

MEDICAL HISTORY

INFORMED CONSENT TO RECEIVE BODY ART

In consideration of receiving body art from Tête-à-Tête LLC, Permanent Makeup Studio,

NOTICE: Tattoo inks, dyes, and pigments have not been approved by the FDA.

-I am the person on the legal ID presented, at least 18 years of age, not under the influence of alcohol or drugs.

-The information I provided in the medical questionnaire is complete and true.

-I understand the permanent nature of tattoos, that removal can be expensive and may leave scars.

-All questions about the procedure have been answered to my satisfaction.

-I have been given written aftercare instructions.

-I understand any information is subject to the federal HIPAA Act of 1996.

-I understand signs and symptoms of infection: redness, swelling, elevated temperature, purulent drainage.

-I understand it is possible to get an infection and will seek medical care if one occurs.

-I will follow all aftercare instructions. I understand touch-ups may be needed.

-I understand I might feel lightheaded, dizzy, or faint before, during, or after the procedure.

-I choose to proceed with this procedure at my own discretion.

PHOTOGRAPHY AND VIDEO RELEASE

Before and after photos/videos must be taken and kept on file. I hereby consent to the practitioners photographing me before and after any treatment performed at my request. I authorize use of such media in albums, social media platforms, and to show potential clients procedures completed.

TECHNICIAN WAIVER AND RELEASE OF LIABILITY

The UNDERSIGNED has been explained the risks and dangers inherent therein. I discharge my own demands, damages, or causes of action against said company, which I, my heirs, executors, or assigns can, shall, or may have. I understand there are no refunds.

POLICIES & SCHEDULING

RESULTS: Healed results may vary due to the organic nature of skin. Results are not guaranteed, and additional sessions (priced accordingly) may be needed to achieve your desired look.  Adherence to the pre-care and aftercare guidelines are strongly advised for optimal results.

FOLLOW-UPS: If you miss your follow-up session (required 5-6 weeks after the initial treatment), or don’t book one within 10 weeks, you will have to book a new full session and will be charged the full price.

PREGNANCY + NURSING: We cannot legally tattoo you while you are pregnant or breastfeeding. If you become pregnant between sessions, you must notify Tête-à-Tête LLC and your follow-up appointment  will be postponed until 3 months postpartum or after nursing. 

ANNUAL MAINTENANCE: To maintain the quality and longevity of your body art, we recommend annual maintenance treatments. These are scheduled a year after your last touch-up appointment, which must have been done at Tête-à-Tête Studio. If your body art is not at least 70% faded by your next annual maintenance appointment, then please consult with your artist before booking. You will have to pay full price if (a) you are NOT a returning customer for that service, or (b) you miss the one-year deadline. It is the client’s responsibility to schedule their annual maintenance appointments on a timely manner. 

COVER-UPS + CORRECTIONS: If you’ve had work done in the desired treatment area by another artist, (even if it’s old or faded) please email a photo for pre-approval. If you skip this step, we reserve the wright to cancel your appointment and refund your deposit.

RESCHEDULING: Deposits are non-refundable and non-transferrable. If you’d like to reschedule, you may do so ONCE before the 48 hour window. If it is less than 48 hours, you will need a new deposit to rebook for a later date. If you are sick, please stay home, and email us to reschedule. 

CANCELLATION: If you cancel your appointment for any reason with less than 48 hours notice, your will be charged $50 cancellation fee. 

LATE POLICY: Please call to say you’re running late! Having to rush compromises the quality of our work and your results, and it affects our other commitments or appointments. If you are 15+ minutes late or miss your appointment, we won’t be able to accommodate you. Your procedure will be cancelled, and your deposit will serve as a no show/cancellation fee. This means you’ll need a new deposit to book again.

18+ ONLY: You must present a valid photo ID to be tattooed. Please don’t bring children with you to your appointment, as it is not a safe or supervised environment for them, and it can distract the artist. If you can’t find care for your child in advance, please reschedule before the 48 hour window.

***A consultation prior to booking your appointment is highly recommended. If the artist decides that you are not a candidate for a specific treatment or you are disrespectful to your artist, we reserve the right to refuse service.

Tattoo Risks & Acknowledgment

I acknowledge and understand that:

1. The tattoo process involves the insertion of pigment into the skin, which may cause minor pain, discomfort, or irritation.

2. There is a risk of infection, allergic reaction, or scarring if proper aftercare is not followed.

3. The ink may fade, spread (bleed), or change in appearance over time due to skin type, lifestyle, sun exposure, and aging.

4. Touch-ups may be required to maintain the tattoo’s appearance.

5. I must follow all aftercare instructions provided by the artist to ensure proper healing.

Minor Tattoo Parental Consent

I, the undersigned parent or legal guardian, certify that I am the lawful parent/legal guardian of the minor named in the above consent form and that the minor is under eighteen (18) years of age.

I hereby give my full consent and authorization for the tattoo procedure requested by the minor to be performed by the tattoo artist and studio listed on this form.

I acknowledge and understand the following:

• I have reviewed the design, placement, and description of the tattoo requested by the minor.

• I understand that tattooing is a permanent procedure and may involve risks including, but not limited to, infection, allergic reactions, scarring, or dissatisfaction with the final result.

• I confirm that the minor has disclosed any known medical conditions, allergies, or medications that may affect the tattoo procedure or healing process.

• I agree to release and hold harmless the tattoo artist and studio from liability arising from the procedure, except in cases of gross negligence or misconduct.

• I understand that valid government-issued identification for both the parent/legal guardian and the minor may be required and copies may be retained by the studio where permitted by law.

  
  

I certify that the information provided is true and accurate.

Tattoo Artist : Sara Gorovits

Tattoo Studio: Tête-à-Tête Studio

We look forward to seeing you! A $100 deposit is required to secure your appointment.

Please submit your payment through Zelle 410-258-8944,

or Venmo through the following link http://venmo.com/u/Sara-Gorovits