Pre-Session Consent — Limitless Tattoo

— section 01 · appointment

Confirm your session.

Full legal name

Date of birth (must be 18+)

Appointment date

Approx. time

Piece being worked on

Placement

— section 02 · contact

How to reach you.

Email

Phone

Address

Emergency contact — name

Emergency contact — phone

Relationship

— section 03 · medical history

Health background.

Check anything that applies. This information stays confidential — I need to know in case anything affects how your skin responds to the work.

Allergies (latex, dyes, antibiotics, etc.)

Current medications

Anything else medically I should know?

— section 04 · day of session

Pre-session confirmation.

Check each statement to confirm. If you can't honestly check all of these, we may need to reschedule for your safety.

I have not consumed alcohol or recreational drugs in the past 24 hours. Alcohol thins your blood and affects healing. Drugs can interfere with sensation, decision-making, and aftercare compliance.

I have eaten a full meal within the past 4 hours and am well-hydrated. Low blood sugar leads to lightheadedness and fainting during long sessions.

I am well-rested and feel physically able to sit for my scheduled session.

I have read and understand the aftercare guide and agree to follow it.

— section 05 · acknowledgments

What I understand.

Read each statement carefully. Check each to acknowledge.

I am 18 years of age or older and have provided valid government-issued ID to verify this.

I understand that tattoos are permanent. Removal is expensive, painful, and never fully complete.

I understand the inherent risks of tattooing — including but not limited to: infection, allergic reaction, scarring, fading, color shift over time, and asymmetry in healed results compared to fresh work.

I have disclosed all relevant medical conditions, medications, and allergies above to the best of my knowledge. Failure to disclose may affect safety and healing.

I take full responsibility for following aftercare instructions. I understand that improper aftercare may result in infection, fading, or scarring, and that the artist is not liable for outcomes resulting from my failure to follow the protocol.

I have had the opportunity to ask questions about the procedure, and any questions I have asked have been answered to my satisfaction.

Release of Liability

By signing below, I, the undersigned, release and hold harmless Jeremiah A. Wright (operating as Limitless Tattoo), Miami Tattoo Company, and any associated parties from any claims, demands, or causes of action arising from or related to the tattoo procedure performed, including any complications resulting from failure to disclose relevant medical information or failure to follow aftercare instructions.

I acknowledge that I am entering into this agreement of my own free will and am not under the influence of alcohol or drugs. I understand this is a legally binding release.

— section 06 · photo release

Optional: permission to share.

Optional and entirely up to you. Check the box only if you want to grant permission for your tattoo to be photographed and shared.

Photo & Likeness Release

By checking the box below, I authorize Limitless Tattoo / Jeremiah A. Wright to photograph or video-record the completed tattoo and to use those images and recordings for portfolio, social media (Instagram, TikTok, etc.), website, and promotional materials.

I understand that no compensation will be provided for the use of these images, and that my face/identity will not be shown in posted photos unless I separately and explicitly authorize it. I may withdraw consent in writing at any time for future use.

Yes — I authorize Limitless Tattoo to photograph my tattoo and use the images for portfolio and marketing as described above.

Optional add-on — Yes, you may include my face/identity in posted photos.

— section 07 · signature

Sign & submit.

Type your full legal name as it appears on your ID. Submitting this form is your electronic signature confirming everything above is accurate and you accept the terms.

Signature (type full legal name)

Date