Laser Consent Form — Prick's Tattoo

Client Information

First Name *

Last Name *

Date of Birth *

Phone *

Email

Address

Emergency Contact Name

Emergency Contact Phone

Service *

Treatment Area(s)

Government-Issued Photo ID(optional — attach a photo or scan)Click to upload ID photo

Health & Medical History

Answer yes or no to each question. * required

Additional notes or conditions

Acknowledgment & Consent

I am 18 years of age or older and have valid government-issued photo ID.I understand that laser treatments may require multiple sessions and results vary by individual.I have been informed of potential side effects including temporary redness, swelling, blistering, and changes in pigmentation.I agree to follow all pre- and post-treatment care instructions provided by my technician.I understand that tanned or recently sun-exposed skin increases the risk of adverse reactions and I will notify my technician of any changes.I release Prick's Tattoo and its laser technicians from liability for complications arising from undisclosed medical conditions or failure to follow aftercare instructions.

Signature (type full name) *

Date

This form is for informational and record-keeping purposes. It does not constitute a medical document.

Laser Treatment Consent Form

Client Information

Health & Medical History

Acknowledgment & Consent