First Name
Last Name
Contact Number
Email Address
D.O.B
AGE
Address
Please read carefully and complete the questions below to the best of your knowledge
Skin Conditions
—Please choose an option—YesNo
Seizures
Diabetes
HIV
Hepitis A,B or C
Allergic Reactions
Pregnant
If you answered yes to any of the above please detail any information required below.
Additional Info
Area to be Tattooed
Tattoo Design
Please sign to confirm you have provided all information to the best of your knowledge and the information is true and accurate, failure to provide the right information may result in your treatment having unforeseen issues and as such The Drawing Room cannot be held responsible.
I fully understand that I must be 18 years of age or over to be tattooed. This is to certify that I, the above named undersigned, do give my permission to be tattooed and I fully aware of the process involved and understand the importance of the daily after-care procedure.
Signature
Date of Treatment
