Emergency contact person:

Client declarations

Please initial each box:

I confirm I am 18 years of age or older and have provided true and complete information in this form.I confirm I am not under the influence of alcohol, recreational drugs, or any substance that may impair my judgment at the time of treatment.I understand cosmetic tattooing is an invasive skin penetration procedure and that results vary between individuals.I understand cosmetic tattooing is semi-permanent to permanent and fading, colour change, migration, uneven retention, and the need for future maintenance or touch-ups can occur.I understand no guarantee or warranty has been made to me regarding the exact colour, shape, symmetry, healing result, longevity, or aesthetic outcome.I understand I may require more than one session to achieve the desired result and that additional fees may apply.I acknowledge that pre-draw shape, pigment selection, and procedure plan have been explained to me, and I approve them before treatment begins.I understand the total cost of today's procedure, and the first retouch is included. Any further touch-up is at my own expense.

Contraindications and practitioner discretion

I understand the practitioner may refuse, postpone, or modify treatment if it is considered unsafe, unsuitable, outside scope, or not in my best interests, including where there are concerns about skin integrity, medical history, infection risk, healing capacity, unrealistic expectations, or consent capacity.

Photography consent

Please choose one option:

I consent to clinical photographs being taken and stored for treatment planning, record keeping, and progress comparison only.I do not consent to photographs being taken except where required for clinical records or incident documentation.

Separate optional marketing consent

I consent to the use of my before-and-after images for marketing, website, portfolio, and social media purposes.I do not consent to any marketing or promotional use of my images.

Medical history and risk screening

Tick all that apply and provide details where relevant:

Pregnant or breastfeedingDiabetesEpilepsyAutoimmune conditionKeloid or hypertrophic scarring historySkin disorder in treatment areaCold sores / herpes simplex historyRecent use of Roaccutane / isotretinoinBlood-thinning medicationBleeding disorderHeart condition / pacemakerCancer treatment historyAllergies to latex, pigments, topical anaesthetics, metals, preservatives, or antibioticsPrevious cosmetic tattooing, laser removal, saline removal, or corrective work in the areaRecent cosmetic procedures in the area, including anti-wrinkle injections, fillers, peels, needling, laser, IPL, HIFU, waxing, tinting, or brow laminationKnown infectious disease or active infectionOther relevant medical condition or medication

I understand the practitioner may refuse, postpone, or modify treatment if it is considered unsafe, unsuitable, outside scope, or not in my best interests, including where there are concerns about skin integrity, medical history, infection risk, healing capacity, unrealistic expectations, or consent capacity.

Liability and acknowledgment

I request and authorise Elke Einfalt to perform the cosmetic tattoo procedure described in this form. I understand that all cosmetic procedures carry inherent risks and that outcomes depend on individual skin characteristics, medical factors, healing response, lifestyle, and aftercare compliance.

I confirm that I have received and understood written and/or verbal aftercare instructions, including signs of infection, activity restrictions, healing expectations, and when to seek medical advice.

Consent to proceed

By signing below, I confirm that:

I have read and understood this entire form.I have had adequate opportunity to ask questions.I give voluntary consent to proceed with the cosmetic tattoo procedure described above.I understand I should seek independent medical advice if I have any uncertainty about my suitability for treatment.