Laserfiche WebLink
Tattoo Consent Form <br /> East Main Tattoo <br /> 2165 E. Main St. <br /> Stockton, CA 95205 <br /> Please fill out this form front and back in clear print. <br /> Name: Age: D.O.B.—/—/ <br /> Driver's License# Phone: - - <br /> Address:— City: State: <br /> Zip Code: Appointment Date: -/—/— Price: <br /> Artist: Placement of tattoo: <br /> Description of tattoo: <br /> PLEASE ANSWER THE FOLLOWING. CIRCLE YES OR NO <br /> 1.Have you ever been tattooed before? <br /> YES NO <br /> 2.Are you 18 years of age or older? <br /> YES NO <br /> 3.Are you hemophiliac or have any other types of bleeding disorders? YES NO <br /> 4.Are you under the influence of drugs/alcohol? <br /> YES NO <br /> 5.Are you pregnant? <br /> YES NO <br /> 6.Do you have Epilepsy? <br /> YES NO <br /> 7.Are you diabetic? <br /> YES NO <br /> 8.Do you have HIV/AIDS? <br /> YES NO <br /> 9.Have you ever been diagnosed with hepatitis? YES <br /> NO <br /> If yes,please explain what type: <br />