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Tattoo Consent Form

Name

Date Of Birth

Address

Phone

I am over the age of 18

Signature

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Health declaration

Please fill out the following form.

First name

Last name

Email*

Date of birth

Day

Month

Year

Have you been hospitalized in the last 12 months?

No

Yes

Are you suffering from a medical condition, illness or injury?

No

Yes

If you answered yes to any of the questions above, please supply additional information.

Initials*

I declare that the info I’ve provided is accurate and complete.

OPENING HOURS:

TUESDAY - SATURDAY

10AM TILL 6PM

46 BROOK STREET,

WARWICK,

ENGLAND,

CV34 4BL

01926492999

COMPANY REGISTRATION NUMBER

12504580

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