Rocking Needles • Tattoo Artist

📋 Personal Information

Full Name *

Date of Birth *

Phone Number *

Email Address

Instagram ID *

Address

Emergency Contact Name

Emergency Contact Phone

🎨 Tattoo Information

Tattoo / Body Piercing Description *

Tattoo Size (in inches) *

Is this your first tattoo? *

How did you hear about us? *

Preferred tattoo artist

🏥 Health Information

Do you suffer from?

I do not have diabetes or blood-sugar-related conditions.

I do not have high blood pressure.

I do not have heart conditions or take blood-thinning medications.

I am not allergic to any creams or foods.

I am not prone to fainting or dizziness.

I do not have any skin conditions (eczema, psoriasis, etc.).

Are you pregnant or breastfeeding?

📝 Consent & Agreements

Age Confirmation: I confirm that I am 18 years of age or older and have provided valid identification. *

Consent to Tattoo: I confirm that I have not consumed any drugs or alcohol in the past 24 hours and that I am fully capable of providing informed consent for the tattoo procedure.

Liability Waiver: I accept all responsibility myself and hold Rocking Needles harmless for any consequences that might steam from my decision to have any Tattoo / Piercing related work done at Rocking Needles. (Also if any touch-up work needed, "After 45 Days" due to my own negligence, will be done at my own expense.) I agree not to sue Rocking Needles in connection with any and all damages, claims, demands, rights and causes of actions of whatever kind of nature, injuries of myself or anyone else arising from my decision to have Tattoo / Piercing related work done this time, whether or not caused by any negligence of Rocking Needles. *

Aftercare Instructions: I acknowledge that I have received and understand the aftercare instructions. I understand that proper aftercare is essential for healing and that failure to follow instructions may result in infection, scarring, or poor healing. *

Photography Consent: I consent to having my tattoo photographed for Your Tattoo Parlour's portfolio, social media, and promotional materials. I understand these images may be used without further compensation to me. *

Digital Signature *

By typing your name above, you are providing your digital signature and agreeing to all terms and conditions.

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Art That
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Art That Matters

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Art ThatMatters

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Art That Matters

Art That
Matters