Consent form | inkexeter

First name

Last name

Phone

Birthday

Day

Month

Year

Are you currently taking any blood thinning or immunosuppressant medication?

Yes

Do you have a history of fainting or dizziness during piercing, tattoo or medical procedures?

Yes

Do you have any allergies to metals, dressings or latex?

Yes

Acknowledgement checkbox:

I confirm that I am not under the influence.
I confirm that I am not pregnant or less than 6 weeks post partum.
I confirm that I am of legal age and voluntarily choosing to have this procedure.
I confirm that I will follow appropriate aftercare as advised to me and in the event of not doing so I accept liability of any complications.
I confirm that I understand the potential risks involved with Tattooing and body piercing which can include infection, bleeding, swelling, bruising, scarring and allergic reactions.