TATTOO & PIERCING CONSENT FORM

Please enable JavaScript in your browser to complete this form.

Your details - Step 1 of 3

Your information

We use your details to prepare for your appointment, check suitability, record consent and provide aftercare support. Relevant health information is reviewed by your practitioner; you can ask to discuss it privately.

Submissions are stored in our website form system. The studio bookings mailbox receives a receipt notification without your health answers or ID documents. Our hosting and email providers help deliver this service. The receipt email sent to you does not include your health answers.

For details about your information, retention and your rights, read our Privacy Policy or contact bookings@theviperpit.co.uk.

Full Name *

Age *

Photo ID - required for clients aged 18 *

Drag & Drop Files, Choose Files to Upload

If you are 18, upload one clear JPG, PNG or PDF, up to 5 MB, showing your photo, name and date of birth. Cover document numbers and other details we do not need. Bring the original ID to your appointment too. Do not email ID documents.

Address *

Phone Number *

Email Address *

Emergency Contact Name *

Emergency Contact Number *

Service Requested *

Tattoo
Piercing

Placement Area *

Signed Name Contact

Tattoo Artist / Piercer Performing Service *

How did you hear about us? *

Google / Google Maps
ChatGPT / another AI assistant
The Viper Pit Instagram
The Viper Pit Facebook
TikTok
Artist's own social media / recommendation
Friend or family
Passing the studio
Returning customer
Other

Please select one option.

Was your appointment booked or a walk-in? *

Please select one option.

Is this your first visit to The Viper Pit?

First visit
Returning customer

Optional — please select one option.

What made you choose us?

Reviews
Artist's work
Recommendation
Location
Price
Other

Optional — please select one option.

Permission to use health information *

I explicitly consent to The Viper Pit collecting, using and storing the relevant health information I provide to assess suitability, provide the procedure and aftercare, and keep the associated consent record.

You can withdraw this permission by contacting the studio. If you prefer not to provide health information online, contact us before submitting to arrange a private discussion. We may be unable to proceed without the information needed for a safe assessment.

Health information *

Diabetes
Epilepsy, fainting, seizures
Heart conditions
Skin conditions
Blood-borne viruses
Pregnant, breastfeeding
Blood-thinning meds, antibiotics
Allergies: ink, metals, latex, plasters, lidocaine
None of the above
I would prefer to discuss relevant health information privately

Select all that apply. Select 'None of the above' only if no listed condition applies. If you prefer to discuss privately, speak with the practitioner before any procedure.

Anything else we should know

Health information declaration *

I have answered the health questions honestly and disclosed relevant information, or will discuss it privately with the practitioner before proceeding.

Age and ID *

I understand that tattoos are strictly for people aged 18 or over. Piercing age limits depend on the piercing. I will bring valid photo ID and, if under 18, attend with my parent or legal guardian and bring any requested documents.

The studio must check age, ID and suitability before the procedure. Completing this form does not confirm eligibility.

Procedure risks *

I understand that tattoos and piercings carry risks, including infection, allergic reaction and scarring.

Alcohol and drugs *

I confirm I am not under the influence of alcohol or drugs.

Deposit agreement *

I understand deposits are non-refundable.

Liability agreement *

I release The Viper Pit Tattoo & Piercing Studio and its artists from liability for complications that may arise.

Aftercare

Your practitioner will provide and explain written aftercare instructions for your procedure at the appointment. Please ask if anything is unclear.

Recommended products are available to purchase if you wish. Purchasing products is separate from your consent and aftercare responsibilities. Ask your practitioner before using alternative products.

Aftercare products (optional)

I would like to discuss purchasing recommended aftercare products.
I do not wish to purchase aftercare products at this time.

Purchasing products is separate from your consent to the procedure and your aftercare responsibilities.

If you would like aftercare products, please ask your practitioner at the appointment.

Aftercare responsibility *

I understand that I need to follow the written aftercare instructions provided for my procedure and ask the studio if anything is unclear.

Photo permission (optional)

I agree to photographs of my tattoo or piercing being taken and kept in my confidential studio record.
I agree to photographs of my tattoo or piercing being used on the studio website and social media. Please ask me before including my face or other identifying details.

Leave either box unticked if you do not agree to that use. Your treatment does not depend on agreeing to photographs.

Before the procedure *

I understand that the practitioner will review my answers, explain the procedure and aftercare, answer my questions and confirm the design or jewellery and marked placement with me before proceeding.

Date Signed

e.g 03-01-2025