test file

E-mail Address:

First Name:

Last Name:

Street Address:

City:

State:

Postcode:

Mobile Number:

Emergency contact Number:

Birth Date:

Gender:
MaleFemaleOthers

Passport/Driver ID*:

Please Take A Picture Of Your licence

How did you hear about us?:

Choose your artist:

Please Circle Yes or NO Truthfully To The Statements And Questions Below

I am 18 years of age or over:
YesNo

Have you eaten within last 4 hours?:
YesNo

Have you consumed alcohol within last 8 hours?:
YesNo

Are you prone to dizzy spells or fainting?:
YesNo

Are you prone to heavy bleeding?:
YesNo

Are you currently taking any blood thinning medicine? (Aspirin, steroids etc):
YesNo

I understand that taking blood thinning agents can affect the healing process of my tattoo:
YesNo

I am completely responsible if this outcome occurs:
YesNo

Are you currrently taking any non-prescribed drug? (Marijuana, Methamphetamine etc):
YesNo

Do you have any fears of medical procedures?:
YesNo

I acknowledge that I am totally responsible for looking after my tattoo during the healing process:
YesNo

I understand that Garage Ink uses top sterilised equipment and single use needles for each new client?:
YesNo

I understand that if I have severe sunburn or rashes, I will be refused my tattoo :
YesNo

I understand that suggestions offered by the tattooist regarding design and placement are offered in accordance with their training and experience :
YesNo

I understand that suggestions offered from the tattooist are offered in accordance with their training and experience but is not to be confused with professional medical advice. :
YesNo

Do you have any additional allergies that we need to be made aware of (e.g. latex, oils and soaps) please indicate? :
YesNo

Date:

Signature:

First Name:

Please Circle Yes or NO Truthfully To The Statements And Questions Below

Declaration

For the safety of yourself and your tattoo artist please indicate by circling if any of these conditions apply to you:

Heart DiseaseDiabetesEpilepsyHIV/AidsHepatitisPoor HeatingPregnant/BreastFeeding KeloidingNone of these

This is to certify that I, the customer named above do give permission to be tattooed at Garage Ink, I have answered all off the above questions truthfully and honestly, I am fully aware of the process involved and understand the importance of applying the daily aftercare.