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Health Declaration & Consent Form

Please fill out the following form before arriving to your Tattoo Appointment.


All of your medical information is confidential under HIPAA regulations and will not be disclosed to anyone other than relevant shop staff and artists. If you have any questions on how certain medical conditions can affect tattoos, please speak with your artist prior to your session. 

Do you have or have you ever had: (check all that apply)
I specifically acknowledge that I have been advised of the facts and matters set forth below, and I agree as follows:
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