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Step by Step Training Manuals and Good Night Stories For Children.

Cosmetic Tattoo Forms

 We can set out your forms with your name address and other information for you. 

Set Up cost is From $50 a firm quote will be given when we work out exactly what you require.

Sterilization book suggested set out.

 

 

 

Client Consultation Form 1

Feel free to copy the information we have provided here.

If you would like us to set out your forms for your salon we have a price list at the end of this page.

  Cosmetic Tattooing Client Consultation Card

"Put Your Salon Name Here"  

Name:_______________ DOB:___________M / F

Address:__________________________________ _________________________________PC______

Phone: Home ______________Mobile __________ Email:____________________________________

Emergency contact: _____________________

Ph: ________________ Mob __________

Under 18yrs of age you must have your Parents/Guardians consent

License Number ________________

Parent or Guardians name:_______________

Parent or Guardian signature_____________

Are you planning to take a holiday within the next six weeks. If yes we will need to postpone your treatment.

 No  Yes  please bring this to my attention.

Do you have any of the following?

Aids No  Yes  
Hepatitis B or C No
 Yes            

High/low blood pressure.  No  yes  if yes, please specify medication____________________________

Are you any of the following?

Pregnant? No  Yes  Diabetic No  Yes  

Unwell at the moment? No  Yes

On medication? No  Yes   please specify____________________________________

Do you suffer with cold sores? No  Yes ______
As this treatment will bring them out.

Have you taken any Aspirin or any other drugs today? No  Yes

Have you had Alcohol in the last 24 hours?
No  Yes  If so we will need to postpone your treatment.

How much alcohol have you had in the last 48 hours? Amount _____Glasses of _____________

Do you faint? No  Yes      

Do you have high or Low blood pressure? No  Yes

 I have had a Colour patch I am happy with the Colour.

 No  Yes

Do you have any allergies to pigments or anaesthetics? No  Yes  if yes please specify______________________

Have you had a cosmetic tattoo previously?

No  Yes  if yes any reactions? ______________________________

Are you considering laser resurfacing or any other Laser Treatment?

 No  Yes     If yes bring this to the attention of your CT Therapist.__________________________________

Lifestyle activities e.g.: swimming, gardening etc_______________________________________

Are you allergic to any of these ingredients?

Note: "Here you will place a list of the ingredients you used in your pigment mix." You will know what these are when you do your Patch Test however they may need to be adjusted.

___________________________________________

___________________________________________

Please specify your expectations of what you would like to achieve from this cosmetic tattoo procedure __________________________________

Aftercare advice is on a separate sheet please read that before signing this form.

The above information you have supplied is kept in full confidence. The information is only used to determine if a cosmetic tattooing procedure can be performed on you.

Disclaimer:

Any information supplied to you today should not be considered a substitute for professional medical advice. If you suspect an infection, call your doctor or tattooist immediately to discuss and/or arrange an appointment.

I the undersigned have read and understood all of the above information. The information I have supplied is true and correct.

Signature: _____________ Date: ______

Guardian Sign: ________________ Date: _______

Office Use.

________________________________ This form should be kept in a safe place and not shared with others. If you sell your salon you must obtain the clients permission to hand over these personal details to the new owner.

Appointment Card Front

Appointment Card Back

Inside The Appointment Card

Suggested disclaimer for the industry.