Consent Form Fields marked with an * are required Do You Have a Heart Condition? Do You Have Epilepsy? Do you Have Any Clotting Disorders? Do You Have Any Blood Borne Viruses? Do You Have Diabetes or Lupus? Do You Have Psoriasis or Eczema? If Yes, Where? Do You Suffer from Keloid Scars? Any Allergies? Skin Allergies? If Yes, Detail Here: Are You On Prescribed Medication? If Yes, Detail Here: Does the Medication Affect Your Blood? Are You Prone to Fainting Attacks? Any Known/Previous Reactions to Dye/Pigments? Artist You Are Seeing Today * First Name * Last Name * Address * Phone * Email * Date of Birth * Date * ID Seen? * Are You Happy for Us to Keep your Details to Keep You Informed About Any Future Promotions and Discounts? * Yes No Recaptcha v2 If you are a human seeing this field, please leave it empty.