InkStack Digital Tattoo Consent Form
Client Information
Full Name: Jamie Rivera
Date of Birth: 1995-03-14
Email: jamie.rivera@example.com
Phone: (808) 555-0287
ID Verified: No
Government ID Type:
ID Number (last 4):
Medical Disclosures
| Condition | Response |
|---|
| Blood thinners / anticoagulants | No |
| Allergies (latex, ink, numbing agents) | YES: Latex sensitivity — use nitrile gloves |
| Pregnant or breastfeeding | No |
| Keloid or abnormal scarring history | No |
| Diabetes | No |
| Heart condition / pacemaker | No |
| Skin condition at tattoo site | No |
| Immunocompromised | No |
| Currently on medication | No |
| Consumed alcohol in last 24 hours | No |
Additional medical notes: Prefers morning appointments. Has reference photos for sleeve concept.
Tattoo Details
Placement: Inner left forearm
Description / Design: Fine-line fern sleeve continuation — stem detail and secondary fronds
Approximate size: Approx. 4" × 6"
Artist: Maya Santos
Legal Disclosures — Hawaii & Florida Compliance
This consent form complies with Hawaii Administrative Rules §11-17 (Tattoo Establishments) and Florida Statute §381.0075 (Body Art). The client acknowledges:
- They are 18 years of age or older and have provided valid government-issued ID.
- They have not consumed alcohol or intoxicating substances within 24 hours prior to this procedure.
- Tattooing is a permanent body modification. Results may vary based on skin type, placement, and aftercare.
- The studio uses single-use, sterile needles and equipment meeting OSHA bloodborne pathogen standards.
- Clients with certain medical conditions (listed above) may face increased risk; they have disclosed all relevant conditions truthfully.
- Any touch-up or correction is at the artist's discretion.
Aftercare Acknowledgment
✓
I have received and understand the aftercare instructions provided by the studio. I understand that proper aftercare is my responsibility and directly affects the quality and healing of my tattoo.
Photo Release
✓
I grant the studio and artist permission to photograph my completed tattoo for portfolio, social media, and promotional use. I waive any right to compensation for such use.
Signature
Typed Name (legal signature): Jamie Rivera
Drawn Signature:
(No signature image)
Date Signed: Tuesday, May 19, 2026 at 12:54 PM UTC
InkStack Digital Consent Record
Form ID: 00000000-0000-0000-0000-000000000013
IP Address: 203.0.113.42
Signed at: Tuesday, May 19, 2026 at 12:54 PM
Template: default-tattoo-consent
This document was digitally signed via InkStack (https://inkstack-4.polsia.app).
It is legally binding under applicable state and federal electronic signature laws (ESIGN Act, UETA).