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I acknowledge that there is a chance I might feel lightheaded, dizzy during or after being tattooed. I <br />agree to immediately notify the practitioner in the event that I feel lightheaded, dizzy and/or faint <br />before, during or after the procedure. <br />I agree to follow all instructions concerning the care of my tattoo, and any touch ups needed because <br />of my own negligence will be done at my own expense. <br />I have read, understand and agree to the information provided above regarding telehealth. <br />Do you have Are you currently taking any Herpes? Hemophilia or <br />Diabetes? medication? Cardiac Valve disease? <br />Yes 0 No Yes 0 No Yes 0 No <br />Date <br />6/29/2023 <br />Client Name* Client Signature * <br />First <br />Last <br />►1 <br />Valid Photo I.D <br />Upload or drag files here. <br />Please take a photo of a valid ID <br />draw type <br />Consent for photography and videos <br />.❑ Yes No <br />