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Tattoo Consent Form

Client Information

Date of Birth
Month
Day
Year
Multi-line address

Tattoo Details

Health Disclosure

Are you under the influence of drugs or alcohol?
Yes
No
FEMALE ONLY: Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
Yes
No
Do you have any skin conditions?
Yes
No

Acknowledgement and Waiver

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Signed Date
Month
Day
Year
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Signed Date
Month
Day
Year
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