Iron Palm Tattoo & Body Piercing Consent Form

Must be 18 or older for body art services. No exceptions. If you have an international VPN turned on disable it while filling out this form.

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Your Name *

First

Last

Name must match your official identification.

Your Email *

Confirm Email

An email address where we can communicate with you.

Your Phone Number *

Preferably a mobile phone but a number we can reach you at.

Your Birthday *

You must be 18 or older to get a tattoo.

Your Instagram @

If a photo of your tattoo or piercing is used. We use this to give you credit. Not required...

How did you find out about us? *

What type of body art are we providing you? *

Select Tattoo or Body Piercing.

Which tattoo artist is working with you? *

Please choose the body artist assigned to you.

What Type of Tattoo are you getting?

American Traditional
Anime
Animal
Blackwork
Black & Gray
Cover-Up
Delicate Dot Work
Flash Tattoo
Fine Line
Flower
Geometric
Graffro Traditional
Japanese Traditional
Japanese Neo-Traditional
Lettering
Mandala
Manga
Neo Traditional
New School
Photo Realism
Portrait
Tribal
Touch Up

CLICK HERE TO REVIEW TATOO AFTERCARE INSTRUCTIONS.

Which Piercing Artist is working with you? *

Please select the Body Artist servicing you.

What type of body piercing(s) are we provding? *

Anti Eyebrow
Anti Tragus
Ashley Piercing
Belly Button or Navel
Bridge
Cheeks
Conch
Cristina / Venus
Ear Lobe (Lower)
Ear Lobe (Upper)
Eyebrows
Exotic
Face Dermal
Faux Rook
Forehead Dermal
Flat Ear
Floating Lobes
Frog Eye
Helix
Industrial
Inner Conch
Labret
Lip
Male Privates
Medusa
Monroe
Nipple
Nose
Orbital
Regular Tongue
Rook
Septum
Smiley
Snake Bite
Snake Eye
Spider Bite
Snug
Surface Dermal
Surface Tragus
Tragus
Vertical Labret

CLICK HERE TO REVIEW PIERCING AFTERCARE INSTRUCTIONS.

Do you have any history of the folloing health conditions? Please consult a phsyician if you have any concerns related to the following health conditions. The health conditions listed may increase halth risks associated with receiving a body art procedure.

History of diabetes of any disorder or medication that affects neurological or immune system in fighting infection.. *

I refuse to disclose an health related conditions.
Yes
No

Bloodborne conditions such as Hepatitis B, Hepatitis C, or HIV. *

I refuse to disclose an health related conditions.
No
Yes

History of hemophilia and or other blood clotting abnormalities. *

I refuse to disclose an health related conditions.
No
Yes

History of skin disease,skin lesions, or skin sensitivities to soap, disinfectants, etc... *

I refuse to disclose an health related conditions.
Yes
No

History of allergies or adverse reactions to pigments, dye, and other skin sensitivities. *

I refuse to disclose an health related conditions.
Yes
No

History of epilepsy, seizures, fainting, or narcolepsy. *

I refuse to disclose an health related conditions.
Yes
No

The taking of medications such as aspirin or other anticoagulants (such as Arafin, Xarelto, Plavix, Eliqis, etc) *

I refuse to disclose an health related conditions.
Yes
No

History or suspicion of adverse reaction to latex or products containing latex. *

I refuse to disclose an health related conditions.
Yes
No

History of Keloid formation. *

I refuse to disclose an health related conditions.
Yes
No

Are you pregnant or have you been pregnant in the last three (3) months. *

I refuse to disclose an health related conditions.
Yes
No

Have you] eaten in the last four hours. *

Are you currently under the influence of drugs or alcohol. *

I, the client, refuse to disclose my medical history. *

Clear Signature

Please read entirely & check to consent. *

I Consent I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo or body piercing and that all of my questions have been answered to my full satisfaction. I understand there is a 10% fee on all services. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows: If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS, or any other communicable disease, heart condition or take medicine which thins the blood I have advised my tattooist. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid), Eczema, psoriasis, rash, infection, lesion, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection, rash, or lesion anywhere on my body, I will advise my tattooist. I acknowledge it is not reasonably possible for the representatives and employees of this tattoo shop to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo , and I agree to accept the risk that such a reaction is possible.I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence or failure to follow such instructions, will be done at my own expense. I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo.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. To my knowledge , I do not have a physical, mental or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a tattoo. I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooist that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.I understand that IRON PALM TATTOOS reserves all rights to use any photos o f my piercing or tattoo. I understand cost for this tattoo will be discussed and agreed upon before work for the tattoo or piercing commences and agree to pay for procedure in full recieving service. I hereby release and forever discharge and hold harmless IRON PALM TATTOOS, the Tattooist and all affiliates, Owners, Managers and Employees from any and all claims, damages or legal actions arising from or connected in any way with my tattoo, or the procedure and conduct used in my performing my tattoo, to the fullest extent allowed by the law.

SMS Consent:

Iron Palm uses SMS to both communicate during your servicing at the storefront and about tattoo & piercing aftercare and body art marketing relevant to your purchase. Do you consent to stay in touch?

Aftercare Acknowledgement. *

I have read the aftercare instructions in the link at the bottom of this page. I fully understand these procedures.

Service Fee

Upon signing this agreement I agree to pay a 10% service fee on all transactions..

Front of Drivers License or Official ID *

Passports, drivers license, and official state IDs accepted. Please take a picture and upload the front of your ID.

Back of Drivers License or Official ID *

Passports, drivers license, and official state IDs accepted. Please take a picture and upload the back of your ID.

Have you paid a deposit? *

Where did you pay the deposit? *

Front Desk
Acuity Scheduling App
Direct To Artist
Facebook/Instagram
Iron Palm Website
Other

Custom Payment Location *

How did you pay the deposit? *

Cash
Apple Pay
Cash App
Credit/Debit Card
Cryptocurrency
Paypal
Zelle
Other

Custom Payment Method

How much was your deposit? *

Please enter numbers and decimals only.

Your Signature *

Clear Signature

Signing completes this form.

If you have a need to contact the Georgia Health Department please contact:

200 Piedmont Avenue, SE
Atlanta, Georgia 30334

404-657-2700

PIERCING AFTERCARE INSTRUCTIONS

TATTOO PREP & AFTERCARE INSTRUCTIONS

Walk-ins Welcome

249 Trinity Ave SW
Suite: B
Atlanta, GA 30303

View map

404-973-7828

ironpalmtattoos@gmail.com

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You must be 18 or older to get a tattoo in the State of Georgia. Apologies but no exceptions.

Fill out the form to contact Vivi

Your Name *

First

Last

Your Email Address *

Confirm Email

Please enter your email address here.

Your Phone Number *

Please remember to choose the country flag your phone is registered in so we have the correct country code.

Tell Lyric TheArtist's why you're contacting her

Select whichever reason you are contacting Lyric TheArtist and then type your message below.

Your Message

Image Upload

Click or drag files to this area to upload. You can upload up to 5 files.

If you wish you may upload the artwork or examples of artwork you want the tattoo artist to consider in making your custom piece. Small videos are fine but we prefer images. Maximum file size is 10mb.

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You must be 18 or older to get a tattoo in the State of Georgia. Apologies but no exceptions.

Fill out the form to contact Vivi

Your Name *

First

Last

Your Email Address *

Confirm Email

Please enter your email address here.

Your Phone Number *

Please remember to choose the country flag your phone is registered in so we have the correct country code.

Tell Vivi why you're contacting her

Select whichever reason you are contacting Vivi and then type your message below.

Your Message

Image Upload

Click or drag files to this area to upload. You can upload up to 5 files.

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You must be 18 or older to get a tattoo in the State of Georgia. Apologies but no exceptions.

Fill out the form to contact Terrence Sawyer.

Your Name *

First

Last

Your Email Address *

Confirm Email

Please enter your email address here.

Your Phone Number *

Please remember to choose the country flag your phone is registered in so we have the correct country code.

Tell Terrence Sawyer why you're contacting him

Select whichever reason you are contacting DB Wyte and then type your message below.

Your Message

Image Upload

Click or drag files to this area to upload. You can upload up to 5 files.

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You must be 18 or older to get a tattoo in the State of Georgia. Apologies but no exceptions.

Fill out the form to contact Rene Cristobal

Your Name *

First

Last

Your Email Address *

Confirm Email

Please enter your email address here.

Your Phone Number *

Please remember to choose the country flag your phone is registered in so we have the correct country code.

Tell Rene Cristobal why you're contacting him

Select whichever reason you are contacting Rene Cristobal and then type your message below.

Your Message

Image Upload

Click or drag files to this area to upload. You can upload up to 5 files.

Send a Message to DB Wyte

Please enable JavaScript in your browser to complete this form.

You must be 18 or older to get a tattoo in the State of Georgia. Apologies but no exceptions.

Your Name *

First

Last

Your Email Address *

Confirm Email

Please enter your email address here.

Your Phone Number *

Please remember to choose the country flag your phone is registered in so we have the correct country code.

Tell DB Wyte why you're contacting him

Select whichever reason you are contacting DB Wyte and then type your message below.

Your Message

Image Upload

Click or drag files to this area to upload. You can upload up to 5 files.