To allow:Artist Name
To tattoo: location of the tattoo on your body
Type of Photo I.D.?
Name as shown on ID
Have you eaten in the last 4 hours? Yes/No
Have you had any alcoholic beverages in the last 8 hours? Yes/No
Are you prone to fainting? Yes/No
Are you prone to heavy bleeding? Yes/No
Do you have to take antibiotics before you see the dentist? Yes/No. If yes please explain
Have you taken any blood thinners in the last 24hrs? Yes/No
Do you have a latex allergy? Or any other allergies? Yes/No. If yes please explain
Are you pregnant or breast feeding? Yes/No
Do you have any other conditions that may effect the healing of this tattoo? Yes/No
Do you have or have you ever had any Communicable diseases? Yes/No .If yes please indicate if you have had any of the following: Hep A,B,C, H.I.V, Herpes, Staph infection?
have signed this release on
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