form

First name*
Surname*
Email*
Mobile*

Age*
Telpehone*
Address*

Emergency Contact Name*
Emergency Contact Telephone*

Pre-Procedure Questionnaire

Are you under the influence of drugs or alcohol?*YesNo

Are you pregnant or breast feeding?*YesNo

Do you have any skin conditions?*YesNo

Do you have a communicable disease?*YesNo

Do you have any allergies?*YesNo

If you answered yes to any of the above please detail below, please also let us know of any medical history we should be aware of? e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related diseases etc.

I allow my tattoo to be photographed and be used for the shop / artist portfolio*

I acknowledge that the shop does not offer refunds*

I agree that the studio does not have a way to identify if I am allergic to the elements or ingredients that will be used for my tattoo*

I understand that I need to take care of the tattoo by following the instructions given to me by the artist/shop*

I understand that I might get an infection if I don’t follow the instructions given to me in regards of taking good care of my tattoo*

I indemnify and hold harmless the shop/artist against any claims, expenses, damages and liabilities*

I confirm that the information provided in this document is accurate and true*

Signature*
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Date*