Synergy Tattoo

1. Personal Information

Full Legal Name *

Date of Birth *

Email *

Phone *

Street Address

City

State

ZIP

Emergency Contact Name *

Emergency Contact Phone *

2. Health History

Check any conditions that apply to you:

Current Medications

Known Allergies

3. Consent & Acknowledgments

I voluntarily consent to receiving a tattoo. I am not under the influence of alcohol or drugs, and I am making this decision of my own free will. *I understand that tattooing involves puncturing the skin with needles and depositing ink beneath the surface, and that this process carries inherent risks. *I understand there is a risk of infection if aftercare instructions are not followed properly. I accept responsibility for following the provided aftercare guidelines. *I understand that allergic reactions to tattoo ink, topical preparations, or aftercare products are possible, though rare.I understand that scarring, keloid formation, or variations in healing may occur, and that results may vary.I understand that over time, tattoo colors may fade or change, and that touch-ups may be necessary at an additional cost.

4. Photo / Media Release

I grant Synergy Tattoo permission to photograph my tattoo and use the images for portfolio, social media, website, and promotional materials. I understand I may decline this without affecting my service. (Optional)

5. Aftercare & Policies

I acknowledge that I will receive aftercare instructions and agree to follow them. I understand that improper aftercare can lead to infection, scarring, or poor healing, and that Synergy Tattoo is not liable for complications due to failure to follow aftercare instructions. *I understand the deposit policy: deposits are non-refundable for no-shows or cancellations with less than 24 hours notice. Deposits are applied toward the total cost of the tattoo. *

6. Age Verification & Signature

I confirm that I am at least 18 years of age and will present valid government-issued photo identification at the time of my appointment. *

Digital Signature (Type Your Full Legal Name) *