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Welcome to DJInk.Art

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Our Services

Service Information

1 hour session
1 hr
120 US dollars
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2 hour session
2 hr
200 US dollars
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3 hour session
3 hr
280 US dollars
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4 hour session
4 hr
350 US dollars
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Portraits
5 hr
400 US dollars
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All day session
8 hr
600 US dollars
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$150 Special
4 hr
150 US dollars
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State Of Missouri

Division of Professional Registration

Patron Consent

Section 1. Patrons Information

Patrons Name (first, middle, last) If patron is under the age of 18 Parent or legal guardian's name shall also be provided*

Birthday*

Month

Day

Year

Address*

Email

Phone*

Patrons Driver License number*

Upload ID (for minors include a copy of their birth certificate and school id*

Procedure to be performed*

Tattoo

Are you currently or have you ever used medications that contain a controlled substance?*

Yes

No

Have you ever been diagnosed by a medical doctor as to having contracted communicable disease such as Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and/or other blood borne pathogens? If so, when?*

Yes

No

Have you ever been diagnosed by a medical doctor as having allergies?*

Yes

No

Have you recently been diagnosed by a medical doctor as to having a disease that could affect the healing process, including diabetes?*

Yes

No

Are you currently under the influence of any illegal substances?*

Yes

No

Are you currently under the influence of an alcoholic beverage?*

Yes

No

Have you been diagnosed with jaundice within the past twelve months?*

Yes

No

Are you currently using any medications that contain blood thinners?*

Yes

No

Are you currently using any medications that weaken the immune system that fights infections?*

Yes

No

Section 3. To Be Completed By Patron

By submitting this form I acknowledge that I am aware certain medical conditions and treatments and/or

medications used to treat those medical conditions may be adversely impacted by the procedure(s) of tattooing and/or body piercing and/or branding. Such medical conditions include but are not limited to, impaired kidney and/or liver function, diabetes, jaundice, medication con-

taining blood thinners and medications that weaken the immune system.

I further acknowledge that the tattoo and/or brand should be considered permanent; that said tattoo and/or brand can only be removed with a surgical procedure; and that any effective removal may leave permanent scarring and disfigurement.

I have read this form and confirm that all the information I have given is correct. I understand that this is a consent form and I agree to be legally bound by it.

I understand that this is a consent form and I agree to be legally bound by it.*

Signature*

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Todays date*

Month

Day

Year

Section 4. To Be Completed By Practitioner

I, David Shepherd, have reviewed this consent form and have advised the above named patron both in writing and verbally of the dangers and contradictions of the procedure that is to be performed.

License Number: 2024022687

Signature of practitioner:

Date:

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