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Tattoo Consent form

You have requested a tattoo treatment that involves minor breakage of the skin surface with a needle, which may complicate with some medical conditions. Please read the following information carefully and if any of these conditions apply to you, please discuss them with your artist prior to your treatment.

Personal information

Date of birth
Day
Month
Year

Tattoo information

Date of tattoo sitting
Day
Month
Year
Tattoo artist
Tom
Chris
Tyler
Ella

Medical questions

COVID-19 symptoms or a positive test
Yes
No
Eczema, Psoriasis, Acne or other skin conditions (more prone to skin infection)
Yes
No
Heart disorder (more prone to serious heart conditions from any blood infections)
Yes
No
High or low blood pressure (can cause light-headedness)
Yes
No
Haemophilia or other bleeding disorders (may result in poor clotting or healing)
Yes
No
Epilepsy or other forms of seizures (medication may cause side effects and result in fitting during treatment)
Yes
No
Diabetes (can reduce healing properties of the skin, resulting in infection)
Yes
No
Hepatitis (may pose a risk for the operator)
Yes
No
Autoimmune disease or treatment causing it e.g cancer treatment (more prone to serious infection, and a risk for operator)
Yes
No
Allergies, especially nickel allergy (may cause serious skin reactions and is present in tattooing products)
Yes
No
Pregnant (immune response affected by pregnancy and any infection may affect the unborn child)
Yes
No
Nursing mother (risk of infection can be risk to the baby)
Yes
No
Medication (side effects may affect bruising, bleeding and recovery from treatment)
Yes
No

Please note: Treatment cannot be undertaken if you are under the influence of drugs or alcohol

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