Tattoo Removal Consent Form
Please be advised that I am obligated to perform procedures in strict compliance with all hygiene and health protection measures. This information is confidential and it shall also be handled in that way.
Name:
*
First Name
Last Name
Email:
*
example@example.com
Phone Number:
*
Birth Date:
*
-
Year
-
Month
Day
Date
Age verification: Please submit a picture of your ID/Passport, must be over 18
*
Are you a client or model?
Please Select
Client
Model
If you are interested in being a model for any of our services please register online. www.MarisGoddessEffects.com/modelsYea
Which area is the PMU or tattoo located?
ex: Brows,lips,eyeliner,other body part?
How did you hear about our salon?
Health Questionnaire
Please understand that this treatment is not for everyone. In order to find out if you are fit for this procedure, please answer the following health questions truthfully. Mari’s Goddess Effects will assume no liability in the event you give false information to obtain the treatment.
Check the box if the following apply to you:
Please list any medical conditions, issues, or medications not listed above:
Terms & Conditions
*
Signature
*
Today's Date
*
-
Year
-
Month
Day
Date
Please save a copy of these instructions. Screenshot or print
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Submit
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