Broken Art Tattoo — Client Consent Form
Broken Art Tattoo
Tattooing Los Angeles Since 2005
You must be 18 years or older to get tattooed in California
Client Informed Consent & Release Form
Broken Art Tattoo
Step 1 of 5
01 — Client Information
By providing your number you agree to receive SMS messages from Broken Art Tattoo including aftercare instructions. Msg & data rates may apply. Reply STOP to opt out.
02 — Government ID
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Driver's license, passport, or state ID
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03 — Tattoo Details
Your artist selects this — determines aftercare instructions sent to client
04 — Health Questionnaire

Required by the California Safe Body Art Act. Answer honestly — your safety depends on it.

05 — Disclosures & Informed Consent

California Safe Body Art Act (Health & Safety Code §119300 et seq.)
Broken Art Tattoo operates in full compliance with the California Safe Body Art Act and Los Angeles County Department of Public Health regulations. All practitioners are registered, all equipment is single-use or properly sterilized, and all procedures follow established bloodborne pathogen control protocols.

Nature of the Procedure
I understand that tattooing is a permanent body modification involving the insertion of pigment into the dermis layer of the skin using needles. I understand that the results are intended to be permanent and that removal is costly, painful, and may not be fully successful.

Risks and Complications
I acknowledge the following risks: infection at the tattoo site; allergic reactions to ink pigments; keloid or hypertrophic scarring; fading, blurring, or migration of ink over time; skin sensitivity; and in rare cases, systemic reactions. I confirm that I have disclosed all relevant health conditions.

Aftercare Responsibility
I understand that proper aftercare is my responsibility and directly affects healing and the final appearance of the tattoo. I agree to follow all aftercare instructions provided by my artist.

Release of Liability
I hereby release Broken Art Tattoo, its owners, artists, and staff from any and all claims, demands, damages, or causes of action arising from this procedure, except in cases of gross negligence or willful misconduct.

Age Requirement
I certify that I am 18 years of age or older. I understand that California law prohibits tattooing minors and that providing false identification is a criminal offense.

06 — Signature

By signing below, you confirm that all information provided is accurate and that you consent to the tattooing procedure under the terms described in this form.

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REF: BA-0000000
Aftercare

Aftercare instructions have been sent to your phone.

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