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Practitioner
Heidi Kaye
Appointment Date
Day
Month
Year
Birthday
Day
Month
Year
Form of ID used
Driving License
Passport
Other
Are you currently under the influence of drugs or alcohol?
Yes
No
Are you currently pregnant or breastfeeding?
Yes
No
Medical conditions or medication

I declare that I give my full consent to the tattooing being carried out by the aforementioned practitioner. I understand that this procedure is a permanent change to my skin and body. I confirm that I understand all potential complications, (eg. infection, swelling) for the procedure undertaken and am willing to go ahead with the procedure at my own risk and my practitioner accepts no liability. I agree that it is my responsibility to look after my tattoo following the guidelines given to me, until the site has healed.

I confirm that the above information provided by me for this consent form is correct to the best of my knowledge, that I am over the age of 18 and that I am not currently under the influence of alcohol or drugs.

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