Rex does Tattoos consent form and appointment booking.

You will be given the opportunity to book an appointment once the consent form is filled out and signed.

By appointment only - same day appointment available whenever possible. 541-844-4266 Open late nights and weekends.
Name. Name. First Last
Phone Phone - ### - ### ####
Is this a cell phone able to receive text messages?
Email
I confirm that I have been fully informed of the inherent, risks associated with getting a tattoo. Furthermore, if I have any questions or concerns related to the associated risks, I will ask the Artist and / or Tattoo Studio before I continue with this consent form. Additionally, I fully understand that these risks, known and unknown, can lead to injury, including, but not limited to infection, scarring, difficulties in detecting melanoma and allergic reaction to tattoo pigment, and / or soap. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo application and freely accept and expressly assume any and all risks that arise from tattooing. (Type your initials below)
I confirm that both the Artist and / or the Tattoo Studio have given me the full opportunity to ask any and all questions about the application of my tattoo(s) and they have been answered to my total satisfaction. (Type your initials below)
I confirm that at the time of filling out this consent form I am not under the influence of alcohol or drugs and will not be under the influence of alcohol or drugs at the time I get the tattoo(s). Furthermore, I am voluntarily submitting to be tattooed by the Artist and / or Tattoo Studio without duress or coercion. (Type your initials below)
I confirm that I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I do not have any other medical or skin conditions that may interfere with the application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant, or if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo. (Type your initials below)
I understand and agree that neither the Artist and / or the Tattoo Studio is responsible for the meaning or spelling of the symbol or text that I provided to them or I chose from the flash (design) sheets. (Type your initials below)
I understand and accept that variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand and accept that over time the colors and the clarity of my tattoo may or may not change due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin. (Type your initials below)
I understand and accept that a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and / or costly and which in all likelihood will not result in the restoration of my skin to it's exact appearance before being tattooed. (Type your initials below)
I acknowledge that I have been given adequate opportunity to read and understand this document, and that is was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against my Artist and / or Tattoo Studio. If any provision, section, subsection, clause, or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from the this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document. Furthermore, I hereby declare that I am legal of age and have provided a valid proof of age and am competent to sign this agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement. (Type your initials below)
Do you agree to release all rights to any photographs taken of you and the tattoo and give consent in advance to their reproduction in print or electronic form?

Do you agree to release all rights to any photographs taken of you and the tattoo and give consent in advance to their reproduction in print or electronic form? YES NO
By signing your name below you are stating that you have read this agreement, understand it, and agree to be bound by it.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date this agreement was signed and agreed to. Date this agreement was signed and agreed to. / MM / DD YYYY
Upload a copy of the front of your I.D. (Required to book an appointment)

Attach Files

JPG, JPEG, and PNG only.
If you have a picture of the tattoo you would like you can upload it here.

Attach Files

JPG, JPEG, and PNG only.
Where would you like this tattoo located?