TATTOO PROCEDURE
CONSENT FORM

Luna Moth Tattoo Studio

First name*

Last name*

Email*

Phone Number

Birthday*

Month

Day

Year

Address*

Gov. Official Identification#*

Choose your artist*

I confirm that I have no medical conditions or communicable diseases (diabetes, epilepsy, hepatitis, HIV/AIDS, tuberculosis, COVID-19) that may affect the tattooing process.*

Yes

I confirm that I have no skin conditions (acne, keloids, eczema, psoriasis, freckles, moles, sunburn) that may interfere with healing.*

Yes

I confirm that I am not under the influence of drugs, alcohol, or medications that may impair my ability to get a tattoo.*

Yes

I understand that Luna Moth Tattoo Studio cannot determine if I will have an allergic reaction to any products used. I will disclose any known allergies below. *

Yes

If any of the statements above do not apply to you, please supply additional information.

I understand that my tattoo may fade or change over time due to aging and sun exposure.*

Yes

I agree to follow all aftercare instructions to ensure proper healing. *

Yes

I acknowledge that card payments include a 4% processing fee and a 4.5% sales tax, while cash payments only incur a 4.5% sales tax. *

Yes

I consent to Luna Moth Tattoo Studio photographing my tattoo for marketing and portfolio use. *

Yes

I acknowledge that Luna Moth Tattoo Studio uses video and audio surveillance for security and quality assurance. *

Yes

By signing below, I confirm that the provided information is accurate, I consent to the tattoo procedure, release Luna Moth Tattoo Studio from liability, and agree to the payment policy.*

TATTOO PROCEDURE CONSENT FORM

Luna Moth Tattoo Studio

TATTOO PROCEDURE
CONSENT FORM