ONCE THE TINY TATTOO & NON-REFUNDABLE DEPOSIT CONSENT FORM IS COMPLETED YOU WILL THEN CHOOSE YOUR DATE AND SERVICE (YOUR FORM WILL ONLY BE SAVED AFTER REQUESTING YOUR APPOINTMENT)* Name * First Name Last Name Date of Birth * MM DD YYYY Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Today's Date * MM DD YYYY Select Your Technician's Name * Andreea Furtado Please Select Tiny Tattoo Size Below * Small (Under3") Medium (3-5") Large (Over 5') Please give a brief description of your desired tattoo Below * Desired Location of Tattoo * Are you pregnant or nursing? * Yes No Do you have a history of cold sores, herpes, or fever blisters? * Yes No Previous problems with tattoos or has your physician advised you not to have a tattoos at this time? * Yes No Are you undergoing/Consuming any of the following treatments/Medications: Aspirin, blood thinners, mood altering drugs, immuno-suppressive medications such as anti-inflammatories or steroids, Radiation/Chemotherapy? * Yes No Are you allergic to ANY of the following: Topical antibiotic preparations or de-sensitizers, latex, metal? * Yes No PLEASE READ AND SIGN * Procedure + Risks I understand this is a tattoo procedure and results may last many years. I understand there may be discomfort. Possible side effects include redness, swelling, bruising, temporary bleeding, fading, or pigment loss. Infection is rare but can occur if aftercare instructions are not followed. Touch-ups may be required to achieve desired results and are not included in the initial cost.* I understand that factors like sun exposure, tanning beds, skincare products, medications, and natural skin changes can affect the tattoo’s appearance over time. Fine line tattoos may fade or shift and require maintenance. I acknowledge that results may vary due to individual skin tone, healing, and lifestyle. Responsibility + Expectations I will communicate my desired color, shape, and placement clearly prior to the procedure. I understand that while every effort is made to ensure symmetry and satisfaction, this is a form of art, not an exact science. I understand this procedure may result in a permanent change to my appearance, and that no guarantees have been made regarding removal or future changes. I acknowledge I’ve had the opportunity to ask all questions, and they’ve been answered to my full satisfaction. I understand the tattooing process involves known and unknown risks, and I accept them. Medical + Health Disclosure I am not pregnant or nursing, and I am not under the influence of alcohol or drugs. I do not have medical or skin conditions (e.g., keloids, eczema, psoriasis, acne, sunburn, rashes) that could interfere with the tattoo. If I do, I will inform my technician. I understand it is not possible to guarantee I won’t have an allergic reaction to pigments or materials. I accept responsibility for proper aftercare and understand poor healing due to negligence may require additional work at my own expense. I understand that variations in color and design are normal, and pigment may appear differently on different skin tones. I understand that skin treatments, laser hair removal, plastic surgery, or other alterations may affect the tattoo's appearance. I confirm I am over 18 and have voluntarily chosen to receive this tattoo. I do not have any condition that would impact my well-being in connection to this procedure. I give permission for photos to be taken and used for marketing purposes (online and print). Office Policies A non-refundable deposit of $200 / $100 / $50 is required to book and will not be returned under any circumstances. A 48-hour notice is required for cancellations. Cancellations within 48 hours or no-shows will incur a $100 fee charged to the card on file. After 2 missed or late cancellations, I understand my next appointment must be paid in full to rebook. If I decline the service upon arrival, I am still responsible for the full service fee. All clients must have a card on file to secure appointments. If I do not confirm my appointment, it may be cancelled and replaced, and I will be charged the cancellation fee. Children under 18 are not permitted in the office. BR Brows + Beauty reserves the right to refuse service or charge applicable fees if these policies are violated. Non-Refundable Deposit Policy I understand that any deposit paid to BR Brows + Beauty is non-refundable, non-transferable, and not a credit. If I cancel or reschedule for any reason, I forfeit the deposit in full. Applies to: $200 – Large Tiny Tattoo $100 – Medium Tiny Tattoo $50 – Small Tiny Tattoo Final Agreement I have read and fully understand this consent form. I accept all risks, responsibilities, and policies as stated above. I am signing this voluntarily. COUPON CODE I give my consent to make this my default Credit card for all digital and in-person payments. * Expiration Date: * Security Code (CVV) REQIRED * Billing Zip Code * Digital Signature * **ONCE APPOINTMENT REQUEST IS ACCEPTED THE CARD WILL BE CHARGED THE DEPOSIT AMOUNT FOR THE SERVICE YOU CHOOSE** Thank you!
