Date of Birth*
Date of Appointment*
Area to be tattooed*
Do you currently suffer or have you ever suffered from the following:-
Heart diseaseHigh blood pressureLow blood pressureAsthmaEpilepsy/seizuresHaemophilia/blood clotting disordersSkin complaints (psoriasis/eczema for example)Keloid ScarsDiabeticHIVHaemorrhagingAre you prone to fainting/panic attacks?Do you regularly take blood thinning medication?Any other relevant health issues?
If you have selected any of the above please give details here:-
Please provide any details of any associated problems which may prevent you from getting tattooed:-
Are you breast feeding
I confirm that I have not tested positive for COVID-19 in the last 48 hours.*
I confirm that I have not been in contact with anyone who has tested positive for COVID-19 in the last 48 hours.*
I confirm that I am not experiencing any symptoms related to COVID-19 in the last 48 hours.*
I declare that all of the information provide is correct to the best of my knowledge!
After consulting with my artist I am happy to proceed with my desired tattoo today.
I will agree and adhere to aftercare advice given and am aware that improper care of my tattoo can result in infection.