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Pre-Appointment Questionnaire

Description of your tattoo

Emergency Contact: Please list the name and phone number of someone I can reach in the event of emergency. For example a friend, roommate, caregiver, partner etc.

COVID-19 Screening

Please answer the following questions honestly.

Do you have any of the following symptoms?
Does anyone in your household have any of the above symptoms?
Have you been in contact with someone who tested positive for COVID-19 within the last 7-14 days?
Is anyone in your household awaiting a CVOID-19 test result due to expsoure?

All of the answers to this COVID-19 screen are true and accurate. I will update my tattooer with any changes between now and our scheduled appointment.

Pre-Session Questions

I currently use a Viatmin A&D Ointment during the tattooing process. To avoid any sort of allergic reaction during our session, please let me know if you have an allergy to the following ingredients: white petrolatum, lanolin, liquid paraffin, vitamin A, and vitamin D, Lavender Oil.
If you do have an allergy to any of the following, I will be using petroleum ointment instead :)

Ointment allergy

Do you have any allergies to topical fragrances or metals?

Topical fragrances or metals allergy

Your comfort and emotional/physical safety are my primary focus during our time together in the studio. Please let me know if you have an accessibility needs, requests, or info that you would like me to know before our appointment. For example: a silent session, prefer not to chat during tattoo but studio music is okay, fear of needles, prefer to shave self, no pictures please, etc etc).

Do you have any questions about our session that you would like answered before our appointment?

Collecting tattoos is an extremely intimate practice that can facilitate extraordinary acceptance in ones body, gender, expression of self, love, relationships etc. This level of intimacy and safety can also sometimes encourage us to share our past trauma, pain, and grief without being invited to share. When this happens, I often feel drained, sad, and at times have take a beat from tattooing to recharge. Know that your comfort and safety is a top priority for me, but I am not a therapist nor do I have the tools to help you process any of your previous traumas. By initialing below, you have read this statement, understand that this is a boundary in my practice to protect my mental health, and will ask for consent before sharing intimate trauma, pain, and grief.

Thanks for submitting!

Consent Form
*Erin (@et__inc)

 

106 Prospect St Bellingham WA 98225

PLEASE INITIAL IN THE BOXES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. FEEL FREE TO ASK ANY QUESTIONS REGARDING THIS WAIVER.

In consideration of receiving a tattoo from Erin, I agree to the following:

*Erin’s Market LLC

I fully inherent risks associated with getting a tattoo. Therefore, I fully understand that risks, known and unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap. Having been informed of the potential risks associated with getting a tattoo I wish to proceed with the tattoo procedure and application and freely accept and expressly assume any and all risks that may arise from tattooing.

- I WAIVE AND RELEASE to the fullest extent permitted by law Erin from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either Erin, or otherwise.- Erin has given me the full opportunity to ask any questions about the procedure and application of my tattoo and all of my questions, if any, have been answered to my total satisfaction. 

Erin has given me instructions on the care of my tattoo while it's healing. I understand and will follow them. I acknowledge that it is possible that the can become infected, particularly if I do not follow the instructions given to me. If touch up work to the tattoo is needed due to my own negligence, I agree that the be done at my own expense.

I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by Erin without duress or coercion.

I do not suffer from epilepsy, hemophilia, heart condition(s), nor do I take blood medication. I do not have any other medical or skin condition that may interfere procedure, application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo.

Erin is not responsible for the meaning or spelling of the symbol that I have provided them or chosen from the flash (design) sheets.

Variations in color and design may exist between the tattoo art I have selected actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and naturally occurring dispersion of pigment under the skin.

A tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed.

I release the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (For assurance, if not initial this provision, please inform Erin to NOT take any pictures of you and your completed tattoo).

I agree that Erin has a NO REFUND policy on tattoos and/or sales and I will not ask for a refund for any reason whatsoever.

I agree to reimburse Erin for any attorneys' fees and costs incurred in any legal action I bring against Erin. I agree that the courts located in Whatcom County within the State of Washington shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to the agreement.

I acknowledge that I have been given adequate opportunity to read and this document that it was not presented to me at the last minute and grasp that I am signing a legal contract waiving certain rights to recover damages against Erin. If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

In the process of receiving my tattoo, I understand that it is necessary for Erin to touch my body in the area where the tattoo will be applied and possibly surrounding areas for preparation and positioning. I acknowledge this is a crucial part of the tattoo application process and I hereby give my consent for such contact. I also understand that I have the right to pause or stop the tattoo session at any point if I feel uncomfortable for any reason. I acknowledge my right to withdraw my consent at any time, and by signing, I am expressing my agreement to maintain open communication with Erin about my comfort levels during the session.

​​​I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND.

Form of Identification

ID #

Thanks for submitting!

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