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Clin-ink 77 Consent Form

First Name

Last Name

Date of Birth

Home Address

Email

To my knowledge i do not or have not suffered from any of the following:

Heart Disease or taking any blood thinning medication

Yes

No

Eczema or any skin conditions

Yes

No

Inpetigo or any other contagious skin rash

Yes

No

Haemorrhaging

Yes

No

Epilepsy or any other seizure inducing conditions

Yes

No

Disabetes (if yes please specify the type in the text box below)

Yes

No

HIV infection, Hepatitis A, B or C

Yes

No

Acne, psoriasis or Cellulitis

Yes

No

Have you consumed alcohol or drugs in the last 24 hours?

Yes

No

Are you pregnant?

Yes

No

Any Allergic Responses? Latex/Plasters (if yes please specify in the text box below

Yes

No

If Yes to any please specify

Current Date

I Understand i must be 18 years of age or older to be tattooed. This consent form is to certify that i, the above named, do give my permission to be pierced/tattooed. I am fully aware of the process involved, the permanent nature of a tattoo or piercing and understand the importance of the daily aftercare procedure. I agree to indemnify and keep indemnified the supplier against all claims or proceedings of any personal injury or damage arising out of, or as a result of, the supply of service. I agree to receiving emails from clinink77

Thanks for submitting!

info@clinink77.co.uk.

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Our Opening Hours

Monday: Appointments Only

Tuesday: 10am - 6:30pm

Wednesday: 10am - 6:30pm

Thursday 10am - 6:30pm

Friday: 10am - 6:30pm

Saturday: 10am - 5pm

Sunday: Appointments Only