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Consent & Medical Disclosure
Florida Gulf Coast Tattoo Expo 2026
Step 1 of 5Personal Information
Personal
Service
Medical
ID & Sign
Artist
Please complete all required (*) fields before continuing.
Personal Information
First Name *Required
Last Name *Required
Date of Birth *Required
Age *Required
Sex *Required
Street Address *Required
City *Required
State *Required
ZIP *Required
Phone *Required
Email *Required
Emergency Contact *Required
Emergency Phone *Required
How did you hear about us? *Required
Service Information
Type of Service
🎨 Tattoo
💫 Piercing
✨ Both
Please select a service type
Tattoo Details
Design Description *Required
Location on Body *Required
First Tattoo?
✨ Yes — First Time!
🎨 No — I Have Tattoos
Please select
Piercing Details
Piercing Description *Required
Location / Placement *Required
Medical Disclosure
⚠️ This information is strictly confidential and will never be shared without your permission.
Allergies
Antibiotics
Alcohol
Latex
Soaps
Cosmetics
Metals
⚠️ Other Allergies?
Describe:
Communicable Diseases
Hepatitis
Syphilis
Herpes
Staph
Gonorrhea
Tuberculosis
HIV
Current Health
⚠️ Currently Taking Medications?
Which medication(s)?
Heart Condition
Faint / Dizziness
Pregnant
Subject to Rashes
Skin Condition
Diabetic
High Blood Pressure
IV Drug User
Epileptic
Hemophilia
Thin Blood
⚠️ Other Health Conditions?
Describe:
Photo ID Verification
📷 HOW TO TAKE YOUR ID PHOTO:
Tap "Take Photo of ID" below
Your camera opens automatically
Hold your ID face-up, all four corners visible
Tap the shutter button, then "Use Photo"
✔ ID Captured
Release & Waiver
FLORIDA GULF COAST TATTOO EXPO 2026 — MEDICAL DISCLOSURE & RELEASE FORM


I HEREBY RELEASE AND FOREVER DISCHARGE THE FLORIDA GULF COAST TATTOO EXPO 2026, THE ATTENDING ARTIST(S) AND THEIR RESPECTIVE STUDIO(S)/BUSINESS(ES), THEIR EMPLOYEES, AND AGENTS FROM ANY AND ALL MANNER AND TYPE OF NEGLIGENCE, LIABILITY, CLAIM, ACTION, DEMAND, AND COMPENSATION, IN LAW AND IN EQUITY, WHICH I HAVE OR MIGHT HAVE, NOW OR HEREAFTER, BY REASON OF MY REQUEST TO BE TATTOOED AND/OR PIERCED.


I ALSO SPECIFICALLY RELEASE AND FOREVER DISCHARGE THE FLORIDA GULF COAST TATTOO EXPO 2026, THE ATTENDING ARTIST(S), THEIR RESPECTIVE STUDIOS, EMPLOYEES, AND AGENTS FOR ANY AND ALL LOSS OR DAMAGE ON ACCOUNT OF INJURY TO MY PERSON OR PROPERTY CAUSED BY NEGLIGENCE OR OTHERWISE, BY REASON OF MY REQUEST TO BE TATTOOED AND/OR PIERCED.


I GIVE PERMISSION TO COPYRIGHT AND/OR PUBLISH ANY PHOTOGRAPH OF MYSELF WITH OR WITHOUT USING MY NAME AS DEEMED PROPER. I REALIZE THAT MISREPRESENTATION OR FALSIFICATION OF INFORMATION IS A CRIME SUBJECT TO PROSECUTION.


I CERTIFY THAT I AM OVER THE AGE OF EIGHTEEN (18), AM NOT INTOXICATED OR UNDER THE INFLUENCE OF ANY NARCOTIC SUBSTANCE, AND MAKE THIS STATEMENT ENTIRELY OF FREE WILL AND SOUND MIND. THIS IS A LEGALLY BINDING CONTRACT.


YOUR ARTIST WILL PROVIDE WRITTEN AFTERCARE INSTRUCTIONS AT TIME OF SERVICE. BY SIGNING, I ACKNOWLEDGE I WILL RECEIVE AND AM RESPONSIBLE FOR FOLLOWING ALL AFTERCARE INSTRUCTIONS PROVIDED.
I have read and fully understand the waiver above. I acknowledge that my personal and medical information is kept strictly confidential and will never be sold or shared with third parties.
You must acknowledge before signing
Customer Signature
Sign below with your finger or stylus:
Customer signature is required
Artist — Review & Sign
⚕️ Hand the device to the artist to confirm and sign.
Artist First Name *Required
Artist Last Name *Required
Shop / Studio Registered Under *Required
Artist Signature
Sign to confirm you have verified the customer's photo ID and reviewed their medical disclosure:
Artist signature is required
✔ I have verified this client's photo ID and reviewed their medical disclosure prior to proceeding with service.
Artist must confirm review
⚓
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