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Do you have any other medical or skin conditions that may affect the outcome of your <br />procedure? <br />Do you use any medications that might affect the healing of the body art you wish to <br />receive? <br />If you answered YES to any of the above, Please explain. <br />Do you have any allergies? <br />List of current medication: <br />How long has it been since you last ate? <br />Have you slept at least 6 hours last night or today? <br />What part of the body are you getting tattooed?. <br />Is there any other information you feel you should provide the tattoo <br />artist? <br />I DECLARE UNDER PERJURY THAT THE NAME ABO VE IS TRUE AND CORRECT. I HAVE <br />READ AND UNDERSTOOD THE INFORMATIONABOVE. <br />SIGNATURE <br />FOR TATTOO ARTIST ONLY <br />LINER LOT, <br />LINER LOT <br />TATTOO ARTIST <br />DATE: <br />LOT <br />LOT <br />LOT LOT. <br />LOT LOT <br />DATE / / <br />