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KINGDOM
TATTOO
COLLECTIVE
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KTC Tattoo & Piercing Consent form
Please fill out all the information below to the best of your ability
First Name
Last Name
Email
Birthday
Age
Phone
Address
Have you been Tattooed before?
YES
NO
Have you been Pierced before?
YES
NO
Are you pregnant or Breastfeeding?
YES
NO
Do you have a heart condition, epilepsy or diabetes? (If yes Please Name:)
YES
NO
Yes Explanation:
Are you a hemophiliac (bleeder) or do you have any known conditions that may cause bleeding or hinder blood clotting? If YES please name:
YES
NO
Yes Explanation:
Do you have any communicable diseases (HIV, AIDS, Hepatitis, (Please be honest) If yes please name:
YES
NO
Yes Explanation:
Do you have any allergies to medication or topical solutions? (If yes please name:)
YES
NO
Yes Explanation:
Are you under the influence of alcohol or drugs prescription or otherwise? (If yes please name:)
YES
NO
Yes Explanation:
preferred pronoun:
She
He
They/Them
I was offered a patch test and refused (Cosmetic Tattoo's)
YES
NO
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