1. Full Name
2. Email
3. Date of Birth
4. Phone Number
5. Tattoo Description
6. Body Location of the Tattoo
7. Appointment Date
8. Who is your Artist?
9. Do you have any allergies or medical conditions? If Yes, which one/s?
10. Do you take any medications? If Yes, which one?
11. I am over the age of eighteen (18)
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12. I acknowledge that it is not reasonably possible for the representatives and employees of THE HERBARIUM to determine whether I might have an allergic reaction to the dyes, pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.
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13. I acknowledge that I have advised my tattoo artist of any condition that might affect the healing of this tattoo.
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14. I am not pregnant or nursing.
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15. I am not under the influence of alcohol or drugs.
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16. I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly if I do not take proper care. I have received aftercare instructions and I agree to follow them.
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17. I acknowledge that THE HERBARIUM does not offer refunds.
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18. I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo.
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19. I acknowledge that if my tattoo includes text, I am responsible for correct spelling, grammar, and punctuation.
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20. I acknowledge that variations in colour and design may exist between any tattoo as selected by me and as ultimately applied to my body.
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21. I acknowledge the decision for obtaining my tattoo is my own free will and choice.
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22. I agree that the tattoo design is correctly drawn to my specifications and I allow for artist interpretation.
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23. I agree to immediately notify my tattooer if I feel lightheaded, dizzy and/or faint before, during, or after the procedure.
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24. I agree that I have not been in contact with Covid-19 and show no signs of being sick.
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