Name *

First Name

Last Name

Phone *

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Date of Birth *

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DD

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Overview & Assumption of Risk *

I understand that receiving a tattoo—whether a design or beauty mark—comes with inherent risks. These include, but are not limited to: infection, scarring, allergic reactions to pigment or prep products, and difficulty in detecting certain skin conditions such as melanoma. I have been informed of these risks and still choose to proceed. I accept full responsibility for any outcomes or complications.

I agree

Medical Eligibility & Disclosure *

I confirm the following:

I am 18 years of age or older.

I am not pregnant or nursing. If nursing, I understand I must avoid breastfeeding for 24 hours after the procedure.

I am not under the influence of alcohol or drugs.

I have not taken Accutane in the past 365 days.

I do not have medical or skin conditions (e.g. diabetes, epilepsy, hemophilia, heart conditions, etc.) that may interfere with healing.

I am not taking any blood-thinning medications.

If I have received an organ or bone marrow transplant, I have followed my physician's pre-procedure antibiotic protocol.

I do not have a mental impairment that may affect my ability to give informed consent.

I have disclosed any communicable illnesses such as colds, flu, HIV/AIDS, or hepatitis.

Design Disclaimer *

I understand that: Neither the artist (Attajaan Ramji) nor Unfiltered Beauty is responsible for the meaning or spelling of any design or text I’ve selected or requested. Minor differences in color and design may occur between the template and final tattoo due to individual skin and placement. Over time, tattoo pigment may fade or blur due to factors such as sun exposure and the natural dispersion of pigment in the skin. Tattoo removal is difficult, costly, and may not fully restore the skin to its original state.

I understand

Aftercare & Touch-Up Policy *

I confirm that I have received and understand the aftercare instructions for healing my tattoo. I acknowledge that failure to follow these guidelines may result in infection, scarring, or poor healing. If my tattoo does not heal well, I understand I may be required to pay for a touch-up session, which may range from $50 to the full rate depending on the situation and care taken.

I understand & agree

Media Consent *

I grant Unfiltered Beauty permission to take before, during, and after photos/videos for use in:

My personal file

Educational or marketing purposes including website, social media, or print (I understand there will be no financial compensation for this usage.)

Payment, Deposit & Refund Policy *

I understand and agree that a $50 non-refundable deposit is required to secure my appointment. I acknowledge that Unfiltered Beauty enforces a strict no-refund policy for all tattoos and related services. I will not request or expect a refund under any circumstance.

I agree

Rescheduling *

At Unfiltered Beauty, appointment times are thoughtfully reserved just for you. To reschedule your appointment, I require a minimum of 7 days’ notice. This allows me to offer your spot to another client and maintain a smooth booking experience for everyone. If you request to reschedule with less than 7 days’ notice, a rebooking fee will apply. If you request to reschedule with less than 48 hours' notice, you will be charged 50% of your original service. To secure a new time slot, you’ll be asked to pay the rebooking fee or full amount upfront, depending on the timing of the change. These policies apply regardless of the reason for rescheduling, including work conflicts, illness, transportation issues, or weather, as each appointment is carefully scheduled in advance. Thank you for valuing the time and care that goes into preparing for your service.

I understand & I agree

Late Arrival Policy *

At Unfiltered Beauty, each appointment is carefully reserved to ensure you receive the full attention and service you deserve If you arrive a few minutes late, a one-time grace period will be offered. If you are 10 minutes late to any future appointments, a $25 late fee will apply. If you arrive 15–20 minutes late and I am still able to accommodate you:
 • Your service time will be shortened to stay on schedule
 • A $75 extended time fee will automatically apply for appointments longer than 1 hour If you arrive more than 20 minutes late, your appointment will be cancelled and you will be charged 50% of the full service cost. 
To rebook, you must pay the full cost of a new appointment. These charges apply regardless of the reason — including traffic, parking, or difficulty finding the studio — as appointment slots are booked exclusively for each client. Thank you for understanding and respecting my time and the commitment I make to every client!

I understand & I agree

Studio Policies *

I understand and agree to the following policies: A non-refundable deposit is required to secure my appointment and will be applied toward my service total. All sales are final. There are no refunds on services, deposits, or gift cards. I confirm I am 18 years or older, not pregnant or breastfeeding, and have disclosed all relevant medical history. I understand my results may vary and no guarantees are made regarding outcomes. I have had the opportunity to ask questions and understand all risks, responsibilities, and aftercare.

I agree

Final Acknowledgement *

I acknowledge that I have read and fully understood this consent form. I have had the opportunity to ask all relevant questions and they have been answered to my satisfaction. By signing below, I confirm that all information provided is accurate, and I understand that this agreement will remain in effect for this and all future procedures conducted by my technician at Unfiltered Beauty.

I agree

Date

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DD

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