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Tatuador Julián Manuel Canelo Rodriguez
INFORMED CONSENT FORM
Address Number Details State Zip code Country
DESIGNATION AND DETAILED DESCRIPTION OF THE FOLLOWING TECNNIQUE
This document is subscribed so that the user, or who represents him/her, gives his/her consent to be
submitted to the following body decoration technique:
Anatomic location Price
Type of tattoo
BlackIncrusted Lot #21230020_947 10/2023/10/2025 nº Reg. AEMPS: 696-PE
Tattoo is a permanent technique for a lifetime which, however, can usually be removed with Laser. Time may involve alteration or discoloration in the area where the technique is applied. The drawing is carried out with sterile needles, single-use articles that have approved inks on the skin. In some cases, a subsequent retouching may be necessary.
It will be previously disinfected in the anatomical area where it will be performed, an anesthetic or aerosol ointment can be applied and the disposable razor blades, gloves and hygienic measures that are necessary will be used.
Certain past or current diseases, possible allergies, scarring problems or other incompatibilities may discourage tattooing. Consult your doctor about the circumstances and also in the days after the application of any complication or reaction.
Prior to the application of the tattoo, you should not drink alcohol or do drugs. Don’t be fasting and do not expose the tattooed area to sunlight or UVA. Follow all these indications, unless there are any medical criteria against these practices, such as a need of taking antiaggregants or anticoagulants and vasodilators. Once the tattoo is done, it is advisable to carry out daily hygiene with physiological saline solution, apply cold in the area for the first days, keep it dry, do not scratch it or treat it roughly, do not rub it, do not perform facial treatments, avoid non-specific cosmetics, avoid exposure to sun and UVA rays, avoid swimming pools, saunas, and beaches etc.
COMPLICATIONS AND CONTRAINDICATIONS
In the unlikely event of an allergy, infection or hypertrophic scars it is advisable to receive medical treatment as soon as possible.
Performing any perforation of the epidermis involves the risk of acquiring a blood disease such as HIV or hepatitis B and C.
For six months after the application of a tattoo, you should not donate blood. The presence of tattoos in certain areas of the body can be a contraindication or an obstacle to the application of certain anesthetic techniques (epidural or spinal anesthesia).
It is not advisable to get a tattoo:
• Pregnant or breastfeeding women, people affected by the same time, surgical techniques, chemotherapy or radiotherapy, local or general infection by bacteria, fungi or viruses, scars not stabilized, recent burns, ulcers or bruises.
• Only under medical supervision if you have diabetes, hemophilia, heart disease, immunosuppression, a valve prosthesis, orthopedic or vascular prostheses. If you are a carrier of HIV, hepatitis or another blood borne disease.
• In no case has allergies to the products used, skin conditions in the area of application, such as moles and keloid spots, thickened angiomas, warts, melanomas, and skin cancer, impetigo, psoriasis, urticaria or chloasma.
hereby have been informed orally and in writing about the tattoo technique, I have understood the information received, I have resolved my doubts, I have no impediment, allergy or disease to do so and I understand and accept its risks. I understand that it is a wound on the skin that can suffer the evolution of any wound, including infection, irritation, and allergy, caused by various reasons such as inadequate healing, specific sensitivity, immune system status and other causes. Any problem derived from my tattoo that is not demonstrated to be caused by malpractice (sterilization, disinfection of the material or facilities) will be at my charge. I will go on the day indicated for the review and will faithfully follow the instructions I have received regarding their care and I will not take drugs or alcohol during their healing. For this reason, I have freely taken the decision to AUTHORIZE THE APPLICATION OF THE TECHNICAL MENTIONED. I give full freedom to the establishment to publish and manage the images taken as it sees fit. I understand and accept that in the realization of a tattoo I can develop an allergy to any of the materials used.
At Sevilla on
USER / LEGAL REPRESENTANTIVE OF THE USER👇🏼
I've read, consented and signed this document and agree to the terms and conditions
DATA PRIVACY AND PROTECTION: in compliance with the provisions of the Organic Law 15/1999 of December 13, Protection of Personal Data, you are informed that the personal information obtained through the completion of this document, will be incorporated, for its treatment, to the corresponding file of personal information. Likewise, you are informed that the collection and processing of said data are intended for the custody of the express consent necessary to perform the requested technique. In accordance with the provisions of the aforementioned Organic Law, you can exercise the rights of access, rectification, cancellation, and opposition by writing to the person responsible for the processing, at the address of INKCUBO indicated at the beginning of this document.
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