Boneshakers Tattoo Studio
Consent Form
Full Name *
Date of Birth *
Phone Number *
Email Address
Tattoo Location on Body *
Tattoo Description *
Do you suffer from any of the following?
History of heart disease or murmurs
Yes
No
High or low blood pressure
Yes
No
HIV, Hepatitis B or C
Yes
No
Any Medical condition which may cause haemorrhaging
Yes
No
Epilepsy
Yes
No
Diabetes
Yes
No
Impetigo, Eczema, Psoriasis or Warts
Yes
No
Allergy to Latex
Yes
No
Are you pregnant or breast feeding?
Yes
No
Are you under the influence of alcohol or drugs?
Yes
No
Are you Taking any medication? If so Please give details below
Yes
No
Medication Details (if applicable)
I confirm I am over 18 years old and understand the legal implications of getting a tattoo at Boneshakers Tattoo Studio.
I understand the risks, aftercare instructions, and potential complications that have been explained to me by the Boneshakers artist.
Digital Signature *
Clear Signature
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