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Informed consent with an intervention

I hereby declare, that I was informed and instructed by a tattooist, who will perform the intervention (“tattooist”), of the tattoo and piercing studio BLACK HOUSE TATTOO s.r.o., with its registered office at Turnovská 477/6, Libeň, 180 00 Praha 8, registration number: 04385322, registered in the Commercial Register administered by Municipal Court in Prague under file number: C 246801 (“studio”), before an intervention (tattooing) about a nature and a method of the intervention, possible complications caused by the intervention, as well as about other related matters to the intervention. I hereby declare, that a tattooist sufficiently explained to me how to take care of a tattoo (as mentioned herein below) and sufficiently answered all my questions.


I hereby declare and I am aware of a fact that I must unconditionally stick to a process of a care of a tattoo and if not, I am aware of possible corollaries (particularly bad healing, health complications and bigger corrections of a tattoo). I am aware of a fact that neither the tattooist nor the studio are liable for corollaries caused by a bad care of a tattoo or by using products not bought from the studio (or by a bad use of products bought from the studio).

I hereby declare that, based on the instruction given to me by a tattooist, I fully understand all risks of the planned intervention and agree with the intervention, even though such intervention will cause a disruption of my body integrity. I hereby declare that I was informed by a tattooist, that during and after the intervention may occur health complications and/or unwanted corollaries and because of the consent and the instruction, neither a tattooist nor the studio are liable for them. I hereby declare that a tattooist instructed me on all possible risks of tattooing, particularly that: 

  • if I do not take care of a tattoo properly, there may occur a local bacterial infection (skin infection) on a tattoo, which is characterized by reddening, puffiness, suppuration and painfulness; 

  •  my body may react to a tattoo with an allergic reaction, which means that there may occur a skin rash on a tattoo; 

  • during a healing process there may occur inflammation (granuloma) in area where ink was applied and the intervention may result in a creation of scars (keloids), particularly if I am prone to creation of a keloid scars; 

  • a tattoo may itch or burn during a magnetic resonation; 

  • a tattoo is permanent and its removal is highly demanding and may not be always 100% effective. 


I hereby declare, that I had informed my treating doctor about the intervention and I am undergoing the intervention with his/her consent. Based on the consultation with my treating doctor there should be no limitation for performing the intervention. I hereby declare, that I had informed a tattooist about my health condition, particularly about circumstances, which may have an influence on a process of the intervention as well as on a healing of a tattoo. I hereby declare, that I am completely healthy, particularly that I do not have a fever, skin rashes, diabetes, immunological and blood clotting disorders, allergies, low blood pressure, hepatitis type B or C, epileptics, hormonal therapy, I am not HIV positive, I am not pregnant, I am not breastfeeding, I am not treated for an oncological illness, I do not have a menstruation, Quincke’s disease, I do not take any pills or antibiotics and if I take any I informed the tattooist about it before the performance of the intervention. I feel physically and mentally very well. I hereby declare, that I am aware of a fact, that if this declaration is not true, there is a possibility of health complications (a tattooist informed me about them) and if they occur, neither a tattooist nor the studio are not liable for them. 

I understand that during a healing period of a tattoo may occur unexpected allergic or immune responses and a healing period may differ depending on a various factors. 

I understand and agree that the intervention performed on a mucous membrane, area of palms, soles of the foot, fingers and toes or a face, there is no guarantee of quality of the intervention, no right for a price reduction nor a free correction of a tattoo. I understand that final shades of colors of healed tattoo may differ from shades of used colors depending on a skin shade, suntan and skin pigment. 

I hereby declare that I have a full legal capacity, I am not influenced by alcohol or drugs, I have already been 18 years old (or I attach the form for minors filled out by my deputy), I am fully responsible for my decisions and legal actions and I agree with agreed price for the intervention. I understand that in case of any complications with a healing of my tattoo, I am obliged to inform the studio via e-mail without any delay, with description of the complication and up-to-date picture of the tattoo. 

I checked the tattoo placement, grammar, and spelling of the text. I realize that the Tattooer is not responsible for the incorrect grammar of the text in the sketch, nor for design elements such as numbers, marks, clockwise positioning and the like. 

Tattoo care with a special membrane 

1. A tattooist cover a tattoo with a special membrane immediately after the intervention. 

2. If a membrane does not unstick and does not leak, wear it for 5 days, then take it off, wash a tattoo and apply a thin layer of moisturizing (sunscreen in summer) cream for every 3-6 hours for 3 weeks. 

3. If a membrane has peeled, is leaking or is unpleasant, peel it off and follow an usual care procedure as mentioned above. 


Complete tattoo healing process takes 21-60 days. A healing period is influenced by many factors, therefore do not compare a healing of your tattoo with other persons or other tattoos you already have. Do not consult a healing process with other people, do not accept and/or follow advices from other inexpert sources apart from your treating doctor. Remember that problem-free and fast healing of a tattoo means 50% of tattoo quality. The best way of healing a tattoo is a right care of a tattoo with a healthy lifestyle. 

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