If you wish to use topical numbing during your cosmetic tattoo service, Michigan law requires that you personally obtain a physician-signed clearance letter confirming that you are medically safe to use topical anesthetic specifically for your cosmetic tattoo service.

Please enter your legal name and date of birth exactly as it appears in your medical records. This form will generate a draft email for you to provide your physician and a draft clearance-letter your physician may sign in return.

If you do not wish to use topical numbing, you may skip this step.