INFORMED VOLUNTARY CONSENT FOR ARTISTIC TATTOOING

[{"lid":"2522007584910","ls":"10","loff":"","li_parent_id":"","li_type":"nm","li_ph":"Marina Krylova","li_title":"First & Last Name","li_name":"Name","li_req":"y","li_inputinrow":"y","li_inputwidth":"1_3","li_nm":"Name"},{"lid":"2522007584911","ls":"20","loff":"","li_parent_id":"","li_type":"da","li_title":"Date of Birth","li_name":"Birth Date","li_dateformat":"DD-MM-YYYY","li_datediv":"dot","li_req":"y","li_dateUnavailFuture":"y","li_dateUnavailToday":"y","li_inputinrow":"y","li_inputwidth":"1_3","li_nm":"Birth Date","li_datemask":"99.99.9999"},{"lid":"2522007584912","ls":"30","loff":"","li_parent_id":"","li_type":"sb","li_title":"Gender","li_variants":"Female\nMale\nNon-binary","li_name":"Gender","li_req":"y","li_inputwidth":"1_3","li_nm":"Gender"},{"lid":"1782466764967","ls":"40","loff":"","li_parent_id":"","li_type":"em","li_title":"E-mail","li_name":"Email","li_inputinrow":"y","li_inputwidth":"1_4","li_nm":"Email"},{"lid":"1782466787097","ls":"50","loff":"","li_parent_id":"","li_type":"ph","li_title":"Phone number","li_name":"Phone","li_masktype":"a","li_maskcountry":"FR","li_inputinrow":"y","li_inputwidth":"1_4","li_nm":"Phone"},{"lid":"1782466803022","ls":"60","loff":"","li_parent_id":"","li_type":"in","li_title":"Emergency Contact (optional)","li_name":"EmergencyContact","li_inputwidth":"1_2","li_nm":"EmergencyContact"},{"lid":"1782391630511","ls":"70","loff":"","li_parent_id":"","li_type":"tx","li_text":"Information About the Procedure<\/strong> Before the procedure began, I was provided with complete information about the process of getting a decorative tattoo. I confirm that I understand and accept the following: <ul><li data-list=\"bullet\">A tattoo is a voluntary cosmetic procedure that involves breaking the skin\u2019s surface;<\/li><li data-list=\"bullet\">A tattoo is a permanent image, and its removal may require multiple sessions and does not always allow for the skin to fully return to its original appearance;<\/li><li data-list=\"bullet\">during the procedure, you may experience pain, increased sensitivity, minor bleeding, and temporary swelling;<\/li><li data-list=\"bullet\">the final result will be visible after complete healing and may differ slightly from the initial sketch due to individual skin characteristics, the regeneration process, and the specifics of pigment application;<\/li><li data-list=\"bullet\">The color, saturation, and clarity of the tattoo may change over time due to the skin\u2019s natural aging process, exposure to ultraviolet radiation, specific aftercare practices, and individual physiological processes;<\/li><li data-list=\"bullet\">The healing period varies from person to person and typically ranges from 2 to 6 weeks, depending on the individual\u2019s physiology, the size of the tattoo, and adherence to aftercare recommendations;<\/li><li data-list=\"bullet\">In some cases, a touch-up may be required after full healing to achieve the desired aesthetic result;<\/li><li data-list=\"bullet\">The tattoo artist cannot guarantee an absolutely identical result, since the final appearance of the tattoo depends not only on the technique used but also on individual differences in skin type, the immune system, and the healing process.<\/li><\/ul>","li_inputinrow":"y","li_inputwidth":"1_2"},{"lid":"1782391655051","ls":"80","loff":"","li_parent_id":"","li_type":"tx","li_text":"Possible Risks and Healing Characteristics<\/strong> It has been explained to me that, like any procedure involving skin damage, getting a tattoo carries certain risks and involves individual healing characteristics. During the healing process, the following may occur: <ul><li data-list=\"bullet\">skin redness;<\/li><li data-list=\"bullet\">moderate swelling;<\/li><li data-list=\"bullet\">increased sensitivity;<\/li><li data-list=\"bullet\">minor bleeding or oozing;<\/li><li data-list=\"bullet\">formation of protective scabs and peeling of the skin;<\/li><li data-list=\"bullet\">itching during the healing period.<\/li><\/ul>Even if the technician follows all sanitary and hygiene requirements and aftercare recommendations, the following may occur in rare cases: <ul><li data-list=\"bullet\">infectious complications;<\/li><li data-list=\"bullet\">allergic reactions to pigments, antiseptics, latex, or aftercare products;<\/li><li data-list=\"bullet\">delayed or variable healing;<\/li><li data-list=\"bullet\">the formation of hypertrophic or keloid scars in individuals with a predisposition;<\/li><li data-list=\"bullet\">changes in the shade or intensity of the pigment after healing;<\/li><li data-list=\"bullet\">the need for additional touch-ups.<\/li><\/ul>Failure to follow aftercare recommendations, mechanical damage to the tattoo, exposure to sunlight, and visiting swimming pools, saunas, and open bodies of water during the healing period may negatively affect the quality of the result and increase the risk of complications;","li_inputwidth":"1_2"},{"lid":"1782475734491","ls":"90","loff":"","li_parent_id":"","li_type":"cb","li_label":"I confirm that I have read the information regarding the procedure, potential risks, and the healing process, that I understand the information provided, and that I have no further questions.","li_name":"readandagree","li_req":"y","li_nm":"readandagree"},{"lid":"1782392506125","ls":"100","loff":"","li_parent_id":"","li_type":"ws","li_rows":"1"},{"lid":"1782391788924","ls":"110","loff":"","li_parent_id":"","li_type":"tx","li_text":"Possible Allergic Reactions<\/strong> During the artistic tattooing procedure, materials and products are used that, in rare cases, may cause individual allergic reactions or hypersensitivity. Potential allergens include: Tattoo pigments (dyes, organic and inorganic pigments, preservatives, and auxiliary components). All pigments used comply with the legal requirements of the country where the procedure is performed. In European Union countries, pigments that comply with REACH requirements are used. Antiseptics used to treat the skin (e.g., chlorhexidine, octenidine, and others). Gloves (latex, as well as certain components of nitrile gloves). Ledocol cooling gel, containing: menthol; propylene glycol; benzyl alcohol; sodium metabisulfite; lactic acid; and the dye CI 42090. Tattoo aftercare products used during the procedure (petroleum jelly, cosmetic ingredients, vegetable oils, lanolin, and other excipients\u2014depending on the product used). Protective films and medical dressings (acrylic or polyurethane adhesive layer). I am aware that an allergic reaction may occur both during the procedure and long after it, even in the absence of similar reactions in the past."},{"lid":"1782392191333","ls":"120","loff":"","li_parent_id":"","li_type":"in","li_title":"Allergies I know I have:","li_subtitle":"Medications, antiseptics, latex, metals, cosmetics, food products, and other substances","li_name":"Allegries","li_req":"y","li_nm":"Allegries"},{"lid":"1782392384187","ls":"130","loff":"","li_parent_id":"","li_type":"ws","li_rows":"1"},{"lid":"1782392570110","ls":"140","loff":"","li_parent_id":"","li_type":"tx","li_text":"Pregnancy and Breastfeeding<\/strong> I am aware that, as of now, there are not enough scientific studies confirming that getting a decorative tattoo is completely safe during pregnancy and breastfeeding. I understand that the main potential risks are not the pigments themselves, but possible complications associated with a breach in the skin\u2019s integrity (infection, allergic reaction, the need for medical treatment, and other unforeseen conditions). I agree to inform the tattoo artist of my pregnancy or breastfeeding status before the procedure begins. If I am pregnant or breastfeeding, I am advised to consult with my doctor beforehand and inform the technician of the recommendations I receive."},{"lid":"1782392604034","ls":"150","loff":"","li_parent_id":"","li_type":"sb","li_variants":"This point does not apply to me.\nI confirm that I am not pregnant and am not currently breastfeeding.\nI am pregnant; I accept the risks and will inform the technician of my due date.\nI am currently breastfeeding; I accept the risks and will inform the technician of how long I plan to continue breastfeeding.","li_name":"Pregnancy","li_req":"y","li_nm":"Pregnancy"},{"lid":"1782467329702","ls":"160","loff":"","li_parent_id":"","li_type":"ws","li_rows":"1"},{"lid":"1782394475930","ls":"170","loff":"","li_parent_id":"","li_type":"rd","li_title":"Are you currently taking any medications?","li_subtitle":"Are you currently taking any medications?","li_variants":"No","li_isownvariant":"y","li_ownvariant":"Yes (please specify the name, dosage, and reason for taking it):","li_radcb":"rb","li_name":"medications","li_defselitem":"1","li_req":"y","li_nm":"medications"},{"lid":"1782394583719","ls":"180","loff":"","li_parent_id":"","li_type":"rd","li_title":"Do you have any chronic conditions?","li_subtitle":"Do you have any chronic conditions?","li_variants":"Not","li_isownvariant":"y","li_ownvariant":"Yes (specify):","li_radcb":"rb","li_name":"ChronicDiseases","li_defselitem":"1","li_req":"y","li_nm":"ChronicDiseases"},{"lid":"1782394612014","ls":"190","loff":"","li_parent_id":"","li_type":"rd","li_title":"Please indicate if you currently have or have previously had:","li_subtitle":"Please indicate if you currently have or have previously had:","li_variants":"None of the above\nDiabetes\nBlood clotting disorders\nHeart and vascular diseases\nEpilepsy\nSkin diseases (eczema, psoriasis, dermatitis, etc.)\nAutoimmune diseases\nImmunodeficiency conditions\nTendency to develop keloid scars\nHepatitis B\nHepatitis C\nHIV infection","li_isownvariant":"y","li_ownvariant":"Other:","li_radcb":"cb","li_name":"diseases","li_radioposition":"1_4","li_radiowidthmobile":"y","li_nm":"diseases"},{"lid":"1782394788214","ls":"200","loff":"","li_parent_id":"","li_type":"rd","li_title":"In the last 72 hours:","li_subtitle":"In the last 72 hours:","li_variants":"None of the above\nConsumed alcohol\nUsed illicit drugs\nTook antibiotics\nTook anticoagulants (Warfarin, Xarelto, Eliquis, etc.)\nTook aspirin or medications containing acetylsalicylic acid\nTook other medications that affect blood clotting","li_isownvariant":"y","li_ownvariant":"\u0414\u0440\u0443\u0433\u043e\u0435:","li_radcb":"cb","li_name":"past72hours:","li_radioposition":"1_4","li_radiowidthmobile":"y","li_nm":"past72hours:"},{"lid":"1782394876762","ls":"210","loff":"","li_parent_id":"","li_type":"rd","li_title":"Do you have any of the following at the intended tattoo area:","li_subtitle":"Do you have any of the following at the intended tattoo area:","li_variants":"None of the above\nMoles\nPapillomas\nScars\nBirthmarks\nInflammation\nRashes\nSunburn\nSkin damage","li_isownvariant":"y","li_ownvariant":"Other:","li_radcb":"cb","li_name":"Skin damage","li_req":"y","li_radioposition":"1_4","li_radiowidthmobile":"y","li_nm":"Skin damage"},{"lid":"1782394933106","ls":"220","loff":"","li_parent_id":"","li_type":"rd","li_title":"Please let us know if you are currently:","li_subtitle":"Please let us know if you are currently:","li_variants":"None of the above\nYou feel unwell\nYou have a fever\nYou have recently had an infectious disease\nYou have recently undergone surgery\nYou are experiencing severe stress or lack of sleep\n\u0421ourse of antibiotics\n\u0421ourse of hormone therapy\n\u0421ourse of immunosuppressive therapy\n\u0421ourse of radiation therapy\n\u0421ourse of chemotherapy","li_isownvariant":"y","li_ownvariant":"Other:","li_radcb":"cb","li_name":"Well-being","li_req":"y","li_radioposition":"1_4","li_radiowidthmobile":"y","li_nm":"Well-being"},{"lid":"1782394999203","ls":"230","loff":"","li_parent_id":"","li_type":"rd","li_title":"Have you ever experienced complications following tattoos, piercings, cosmetic procedures, or surgical procedures?","li_subtitle":"Have you ever experienced complications following tattoos, piercings, cosmetic procedures, or surgical procedures?","li_variants":"Not","li_isownvariant":"y","li_ownvariant":"Yes (describe):","li_radcb":"cb","li_name":"Complication","li_radioposition":"hor","li_nm":"Complication"},{"lid":"1782395065253","ls":"240","loff":"","li_parent_id":"","li_type":"cb","li_label":"I confirm that I have provided accurate and complete information about my health. I understand that withholding information about medical conditions, allergies, medications I am taking, or other physical characteristics may affect the safety of the procedure, the healing process, and the final result.","li_name":"Provided accurate information","li_req":"y","li_nm":"Provided accurate information"},{"lid":"1782392642743","ls":"250","loff":"","li_parent_id":"","li_type":"ws","li_rows":"1"},{"lid":"1782393010372","ls":"260","loff":"","li_parent_id":"","li_type":"tx","li_text":"Pain Management and Use of Cooling Gel<\/strong> I am aware that the artistic tattooing procedure may be accompanied by pain, a burning sensation, and discomfort. I understand that the tattoo artist is not a healthcare professional, does not administer injectable anesthesia, and does not prescribe medications. At the client\u2019s request, Ledocol cooling and soothing gel\u2014which is not a medication and does not contain lidocaine\u2014may be used during the procedure. Gel ingredients: water; propylene glycol; menthol; allantoin; cellulose; lactic acid; triethanolamine; sodium metabisulfite; benzyl alcohol; CI 42090 dye. It has been explained to me that the gel\u2019s action is based on the cooling effect of menthol and may help: <ul><li data-list=\"bullet\">temporary relief from burning and discomfort;<\/li><li data-list=\"bullet\">a soothing effect on the skin;<\/li><li data-list=\"bullet\">a cooling sensation during the procedure;<\/li><li data-list=\"bullet\">minimal impact on skin texture.<\/li><\/ul>I understand that using this product does not guarantee complete elimination of pain and is not a medical anesthetic. The cooling gel may only be applied at the client\u2019s request."},{"lid":"1782393423428","ls":"270","loff":"","li_parent_id":"","li_type":"ws","li_rows":"1"},{"lid":"1782393430753","ls":"280","loff":"","li_parent_id":"","li_type":"rd","li_title":"Photography and Videography","li_subtitle":"To document the work performed, ensure quality control, maintain a portfolio, and support their professional practice, a tattoo artist may take photos and videos of the tattooing process and the final result.","li_variants":"I authorize the taking of photos and videos of the tattooing process, as well as the publication of photos and videos depicting the tattoo in the artist\u2019s portfolio, including on their official website, Instagram, other social media platforms, professional directories, and specialized online resources.\nI authorize photography and video recording, but only if my identity cannot be identified (without showing my face).\nI do not authorize photography or video recording during the procedure, nor do I authorize the publication of such materials on the Internet.","li_radcb":"rb","li_name":"Photo","li_req":"y","li_nm":"Photo"},{"lid":"1782393675530","ls":"290","loff":"","li_parent_id":"","li_type":"ws","li_rows":"1"},{"lid":"1782393682390","ls":"300","loff":"","li_parent_id":"","li_type":"tx","li_text":"Service Cost, Payment Policy, and Rescheduling<\/strong> The cost of an artistic tattoo service consists of two separate stages. Rescheduling or Canceling an Appointment<\/strong> If necessary, the client may reschedule the session by notifying the artist in advance. If work on a custom design has already begun, the design fee is retained for the work completed and is non-refundable. When an appointment is rescheduled, the cost of the paid design is applied toward the new session.","li_inputinrow":"y","li_inputwidth":"1_2"},{"lid":"1782468456672","ls":"310","loff":"","li_parent_id":"","li_type":"tx","li_text":"The Artist's right to refuse to perform the procedure<\/strong> The artist has the right to refuse to perform the procedure or to reschedule it in the following cases: <ul><li data-list=\"bullet\">if contraindications are identified;<\/li><li data-list=\"bullet\">if the client withholds important information about their health;<\/li><li data-list=\"bullet\">if there are signs of alcohol or drug intoxication;<\/li><li data-list=\"bullet\">if the client exhibits aggressive or inappropriate behavior;<\/li><li data-list=\"bullet\">if circumstances arise that threaten the safety of the client or the artist<\/li><\/ul>","li_inputwidth":"1_2"},{"lid":"1782393718595","ls":"320","loff":"","li_parent_id":"","li_type":"in","li_title":"Custom Design Development","li_subtitle":"Payment for design development must be made within 48 hours of order confirmation, but no later than 12 hours before the start of the session. Once work on the sketch has begun, the design development fee is non-refundable.","li_name":"DesignFee","li_req":"y","li_inputinrow":"y","li_inputwidth":"1_2","li_nm":"DesignFee"},{"lid":"1782394003525","ls":"330","loff":"","li_parent_id":"","li_type":"in","li_title":"Total cost (including the design fee)","li_subtitle":"The cost of a cosmetic tattoo procedure is agreed upon with the client before the session begins. Payment is made in full immediately after the session is completed.","li_name":"FullCost","li_req":"y","li_inputwidth":"1_2","li_nm":"FullCost"},{"lid":"1782394215673","ls":"340","loff":"","li_parent_id":"","li_type":"cb","li_label":"I confirm that, prior to the start of the procedure, I have been informed of the cost of the services, the payment procedure, and the terms for rescheduling an appointment; I understand these details and agree to the stated terms.","li_name":"PaymentAgreement","li_req":"y","li_nm":"PaymentAgreement"},{"lid":"1782394314493","ls":"350","loff":"","li_parent_id":"","li_type":"ws","li_rows":"1"},{"lid":"1782394321649","ls":"360","loff":"","li_parent_id":"","li_type":"tx","li_text":"I confirm that I have received the tattoo aftercare instructions and agree to follow them. I understand that failure to follow the aftercare instructions may result in: <ul><li data-list=\"bullet\">infectious complications;<\/li><li data-list=\"bullet\">delayed healing;<\/li><li data-list=\"bullet\">loss of pigment;<\/li><li data-list=\"bullet\">a less-than-desirable aesthetic result.<\/li><\/ul>","li_inputinrow":"y","li_inputwidth":"1_2"},{"lid":"1782394346478","ls":"370","loff":"","li_parent_id":"","li_type":"tx","li_text":"I confirm that: <ul><li data-list=\"bullet\">I have received complete information about the procedure;<\/li><li data-list=\"bullet\">I had the opportunity to ask questions and received clear answers;<\/li><li data-list=\"bullet\">I understand the nature of the procedure, its irreversibility, and the possible risks;<\/li><li data-list=\"bullet\">I am making this decision voluntarily;<\/li><li data-list=\"bullet\">I consent to having a decorative tattoo applied.<\/li><\/ul>","li_inputwidth":"1_2"},{"lid":"1782469365575","ls":"380","loff":"","li_parent_id":"","li_type":"tx","li_text":"I confirm that: I have carefully read this document; I have received answers to all my questions; I have provided accurate information about my health; I have reached the age required by the laws of the country where the procedure will take place; I voluntarily give my informed consent to have a decorative tattoo applied.","li_inputinrow":"y","li_inputwidth":"1_2"},{"lid":"1782469355522","ls":"390","loff":"","li_parent_id":"","li_type":"tx","li_text":"I hereby consent to the processing of my personal data solely for the following purposes: <ul><li data-list=\"bullet\">to prepare documentation;<\/li><li data-list=\"bullet\">to communicate with me;<\/li><li data-list=\"bullet\">to comply with legal requirements;<\/li><li data-list=\"bullet\">to retain documents for the period required by law.<\/li><li data-list=\"bullet\">My personal data will not be disclosed to third parties, except as required by law.<\/li><\/ul>","li_inputwidth":"1_2"}]