You will need to check off all of these boxes on the consent form before your appointment in the shop. If you fail to do so or haven’t previously contacted us regarding any of these questions, your appointment will automatically be cancelled.

  • I am over the age of 18, and have truthfully represented my age

  • I have eaten in the last two hours

  • I am not under the influence of drugs or alcohol

  • I do not have diabetes, high blood pressure, heart conditions, heart disease, or any other conditions that could interfere with the body art procedure

  • I do not have any conditions that compromise my immune system

  • I have never suffered from any communicable diseases i.e. hepatitis A, B, or C, HIV, or any other disease that could be transferred to another person during the procedure

  • I am not pregnant or breastfeeding

  • I am not under the treatment of anticoagulants, medications or any supplements that thin the blood and/or interfere with blood clotting

  • I do not have any medical or skin conditions that may interfere with the tattoo

  • I realize that variations in color and design may exist between any tattoo as selected by me as applied to my body and understand that reactions to pigments is still possible even after the tattoo has healed

  • I do not have any known allergies or adverse reactions to latex, iodine, pigments, dyes, disinfectants, soaps, metals, essential oils, or other such products

  • I do not suffer from hemophilia, epilepsy, narcolepsy, dizziness, fainting, or any form of seizure, causing condition that could interfere with the procedure

  • I understand that every care has been taken to ensure this procedure has been carried out in a hygienic manner, and after care of the tattoo is my sole responsibility

  • I agree that any touchup work is needed due to my own negligence, will be my own expense

  • I acknowledge that both written and verbal instructions regarding risks outcome and after care were expressed to me

  • I understand that tattoo procedure should be considered permanent changes to my body and that tattoos may only be removed the surgical or laser procedures any removal procedures may leave scarring or shading of my skin

  • I understand that if I have any skin treatments, laser, hair, removal, plastic surgery, or other skin altering procedures, it may result in changes to my tattoo

  • I consent to any actions or conduct of the representatives and employees of the The Libra Club  necessary to perform the procedure

 Please disclose any other information that would aid the artist in evaluating your body art healing process*