Legal Name *

As it appears on your ID

First Name

Last Name

Date of Birth *

For iPhone: Tap on the Calendar For Android: Tap on the Year

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you taking METFORMIN? *

METFORMIN is a pharmaceutical drug used for Diabetes, PCOS, etc., and can affect your Tattoo. Please ask your Artist for more information if you are unsure about the risks.

I am NOT taking METFORMIN for PCOS, Diabetes, etc.

I AM taking METFORMIN for PCOS, Diabetes, etc., and I'm aware of the risks

I Certify That *

I am not under the influence of Drugs or Alcohol

I am not Pregnant or Nursing

I do not have any form of communicable disease (HIV, Hepatitis, etc.)

By checking off the following, I understand, consent to or agree that *

This procedure is permanent and will change my skin

I have voiced all questions or concerns

Sprouted Beans Tattoo Studio does not provide refunds on any products or services including Tattoos, Artwork, Deposits, etc.

My Artist does not have a way of identifying whether or not I am allergic to the elements and ingredients that will be used for my tattoos and cannot be held accountable for any reaction that may arise

There is a chance that I might feel lightheaded and nauseous, anxious, and/or dizzy or faint during or after getting tattooed

My tattoo may be prone to fading over the years, even more so if located in a “high-traffic area” (fingers, hands, and feet)

I understand the touch-ups may not be free if they are located in a “high-traffic area” or if I fail to protect my tattoo properly from the elements, including but not limited to sun damage

I will have ample opportunity to check over my design prior to it being tattooed on my body. I release Sprouted Beans Tattoo Studio and its artists of all legal responsibilities should any spelling errors or incorrect dates occur

I will have ample opportunity to carefully examine the stencil and design to be tattooed on my body, I approve of the overall design, and I understand that it is correct, and to my satisfaction upon being placed on my body

I acknowledge that it is my responsibility to check with and communicate to my artist if any changes to the design or placement are required prior to being tattooed

My tattoo might get an infection if I don’t follow the proper aftercare instructions

I need to take care of the tattoo by following the instructions given to me by my Artist, and that if I fail to properly care for my tattoo, touch-up will be done at my own expense

To release and forever discharge and forever hold harmless, Sprouted Beans Tattoo Studio, and the Artists and representatives from any and all claims, damages, or legal actions arising from or connected in anyway to my tattoo procedure

Date of Signature *

MM

DD

YYYY

Photo Consent *

I consent to having photos taken of my tattoo for portfolio or promotional use.

Yes, please!

No, thank you

Silent Appointment (optional)

A silent appointment is for anybody who would prefer to not engage in conversation with the artist during their Tattoo — feel free to throw on some headphones, break out a book or get into the zone instead of having to chat!

Silent Appointment

Non-Silent Appointment