THE BLACK LEI TATTOO LLC

Tattoo Consent & Release · Lakewood, Washington


Client & Procedure

Full legal name: __________________________________ DOB: _______________

Address: __________________________________________________________

Phone: __________________________ Email: ___________________________

Photo ID checked by: __________________________ Age 18+ verified: ☐

Artist: _______________________ Date: ___________ Placement: ______________

Tattoo description: ___________________________________________________

Health Screening (Complete Privately at the Studio)

Discuss allergies, skin conditions, medications affecting bleeding or healing, previous tattoo reactions, and other relevant health concerns privately with the artist before the procedure. The studio should maintain any sensitive records securely.

Informed Consent

☐ I am 18 or older and voluntarily consent to this tattoo procedure.

☐ I understand tattoos are permanent and may involve infection, allergic reaction, scarring, pigment changes, or other complications.

☐ I had the opportunity to ask questions and understand that healed results can vary.

☐ I have received and understand aftercare instructions.

☐ I understand I may withdraw consent before or during the procedure.

Photography (Optional)

☐ Portfolio / social media permission   ☐ Private records only   ☐ No optional photography

Signatures

Client signature: __________________________ Date: _________________

Artist signature: ___________________________ Date: _________________

Draft for legal and Washington regulatory review before use. Do not use this public page to submit sensitive health information.