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Consent Form

Please fill this form out before your tattoo.

CLIENT INFO

Name *
Name
First
Last
MM/DD/YYYY
Address
Address
City
State/Province
Zip/Postal
Type of Identification Provided
Type of Body Art
Artist/Technician *
Maximum upload size: 268.44MB

MEDICAL HISTORY

Please Select Any Conditions Listed Below that Apply to You
Are you allergic to cocoa butter or latex? *
Do you have any additional allergies, such as to metals, soaps, cosmetics, or alcohol? *
Do you have any condition that requires you to take medications such as anticoagulants that thin the blood or interfere with blood clotting? *
Have you ever been prescribed antibiotics prior to dental or surgical procedures? *
Do you have any other medical or skin conditions that might affect the outcome of this procedure? *
Do you have any cardiac valve diseases? *

INFORMED CONSENT TO RECEIVE BODY ART

Please read and sign when you are certain you understand the implications of signing.

Read and check off all statements below:

In consideration of receiving BODY ART from the practitioner listed above at Weird Ink Society (together with its employees and other technicians, the "Establishment", I, the below signed, confirm the following by checking each applicable item below: *
Please check the box to confirm the following statement: *
Clear
Please have your artist sign below.
Clear
Artist, please review Medical History before signing.
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