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0 0 <br /> Client record — Permanent Cosmetics and Tattooing Informed Consent <br /> Last Name First Name Date <br /> Address <br /> Street Apt. # city state Zip <br /> Date of Birth Location on Body Name of Practitioner <br /> COPY OR DESCRIPTION OF PERMANENT COSMETIC OR TATTOO <br /> I accept this design or procedure. Client Signature <br /> I.D. I.D. <br /> Permanent Cosmetics and Tattooing Page 1 of 3 <br />