DECLARATION OF CONSENT
First and last name
Street + house number, postcode + city
will be recieving a tattoo today,
at the tattoo studio DOWNTOWN TATTOO JENA
by the tattoo artist
with the following motif
on the following part of the body
1. Do you have a blood disorder or an increased tendency to blood pressure?
2. Do you have a skin disease (neurodermatitis, etc.)?
2.1 If yes, which?
3. Are you taking blood-thinning medication (Marcumar / Aspirin / Heparin / etc.)?
4. Do you have any allergies?
4.1 If yes, against which allergens?
5. Do you have any heart or circulatory problems?
6. Are there infectious diseases? (Hepatitis / HIV / MRSA / etc.)
6.1 If yes, which?
7. Have you taken any medication today or in the last 7 days?
7.1 If yes, which?
8. Do you have any other acute or chronic illnesses?
8.1 If yes, which?
9. Have you consumed alcohol and/or other narcotics in the last 24 hours?
10. Have surface anesthetics (e.g. numbing cream) been applied in the last 24 hours?
11. Are there impairments in the ability to form or exercise one's will?
12. Has surgery or radiation treatment been performed in the area to be tattooed
13. Is there a tendency to keloid formation or sarcoid?
14. In the past 4 months, has the skin been exposed to more than normal levels of UV radiation?
FOR FEMALE CUSTOMERS
15. Are you pregnant?
16. Are you breastfeeding?
17. Insofar as scars are to be tattooed, these have existed since
(Note: For scars that are less than a year old, a tattoo
regularly not recommended).
18. Insofar as the affected skin area has been subjected to laser treatment
The customer was made aware of the following:
1. When tattooing, the tattoo color is inserted into the second layer of skin with needles,
the dermis. Since the skin is injured and this is painful,
if the process is factually a bodily harm according to §
223 para. 1 StGB.
2. The texture of a tattoo depends not least on the
skin texture of the customer. It can therefore be between
Template and the finished tattoo may vary slightly, in terms of shape
and color, come. Also subject to a tattoo at the same time as the living
tissue aging processes. These are particularly strong
Sun exposure (particularly frequent sunbathing, solarium, working in the
outdoors, etc.) accelerated. This can cause the colors to fade and the contours
of the tattoo become blurred. This can be countered with appropriate countermeasures
(e.g. not using a solarium, sun protection, good skin care).
3. Despite the utmost care, caution and proven techniques and work materials,
In rare cases, side effects can occur during or after tattooing
and/or complications such as:
- Circulatory problems, chills
- slight bleeding from the tattoo
- Swelling of the skin with itching and redness
- slight scarring
- unwanted color gradients (so-called blow-outs) due to a
unfavorable connective tissue of the customer
- Tattoo photosensitivity
- Occurrence of keloids or sarcoidosis
- non-allergic foreign body reactions.
In very rare cases, despite the greatest care in terms of hygiene and
Cleanliness - especially as a result of improper post-treatment of the tattoo
Infections and/or spread of germs. Also were in rare
Cases of intolerance (e.g. allergies) to individual colors have been observed. Should
If such a case occurs, we ask that you notify us immediately and
significant impairments to consult a doctor. Due to § 52 paragraph 2
SGB V it can happen that the statutory health insurance in the event of a
complication where the customer takes recourse.
4. If the tattoo is an over-tattoo (cover-up or blast
Over), it is pointed out that it is not possible to predict in advance whether
a cover of the old tattoo at all and possibly with
how much time and effort is required. Furthermore, it cannot be ruled out
that there are interactions with the tattoo ink that has already been applied
tattoo to be covered.
5. Was there a pre-existing tattoo on the area to be tattooed?
Tattoo - by whatever method - removed or lightened, exists
the particular danger that the result of the tattoo to be stabbed afterwards
deviates from the desired result. The skin can absorb its color
be impaired or particularly prone to scarring. The same thing
applies to tattooing stretch marks or scars.
6. As the tattooing process is painful, it may be jerky and for the
unforeseeable movements or similar on the part of the customer. In spite of
the tattoo artist can fix it more easily by applying pressure and tensing the area of skin
do not completely prevent the body and reflex response, only try to
minimize. In rare cases, the quality of the tattoo may vary accordingly
influenced: The needle guidance cannot be carried out evenly and precisely,
so that there may be irregularities, especially with lines.
7. In unusual cases, the skin's ability to absorb tattoo pigment,
limited by their nature. Unfortunately, such cases are in advance
unpredictable and make it difficult to achieve an aesthetically pleasing result
achieve. Favoring factors for such a skin condition are significant
UV exposure and steroid abuse.
8. Due to the specifics of those requested by the customer
Tattoo must also be advised of the following:
We will take photographs of the completed work. Of the
Customer hereby expressly agrees that these photographs beyond
a purpose permitted under Art. 6 Paragraph 1(f) EU-DSGVO for the purpose of
External presentation on our website, our social media appearances (Facebook,
Instagram, Twitter, etc.) or published on advertising banners.
In addition, health data is collected with this declaration of consent so that
we can decide whether to carry out the contract without risk to yours
health and without impairing the result of our work.
Therefore, without this data collection, the contract cannot be carried out by us
will. This data is special data within the meaning of Art. 9
EU GDPR. You hereby expressly consent to their collection.
We do not pass this data on to third parties and they are used for
Stored with us for a period of 10 years. After that, the
Declaration of consent and this declaration of consent destroyed.
This consent can be revoked at any time (Art. 7 Para. 3 EUDSGVO).
According to this, we are allowed to process the data collected under the consent
and/or photographs used. The raised
Health data are - since their processing up to the time of revocation
is legitimate – kept until the end of the retention period.
I have read and understand the foregoing. I feel fit and healthy.
The proper aftercare of a tattoo was explained to me and I
understood this explanation. I certify the above information
truthfully and carefully. About the risks of tattooing
and I was fully informed about their proper follow-up care. I
confirm that the template to be engraved corresponds to my wishes in terms of design.
Against this background, I declare my consent to the implementation of the
Your first and last name + signature
IMPRESSUM / DATENSCHUTZ
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