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0 <br /> Test <br /> I agree to immediately notify the artist in the event I feel lightheaded, dizzy, and/or <br /> faint before, during, or after the procedure. <br /> Test <br /> If I fppl/cpp anv infprtinn cvmntnmc 1 will rnnci ilt with my nrimary carp doctor, <br /> Test <br /> I have been fully informed to the risks of tattooing involving but not limited to; <br /> niaamprntlatpx glnvpc, anrd antibintircIlavina hppn infnrmp� of the nntpntial rickc <br /> • - g <br /> associated with getting tattooed, I still wish to proceed with the tattoo application <br /> and I assume any and all risks that may arise from tattooing <br /> Client Record: Check all that apply <br /> Diabetes,Epilepsy,Fainting/ Dizziness,Heart Conditions /Cardiac,Scarring/ <br /> Keloiding,Allergic Reactions to Latex,Hemphilia,Herpes,Herpes in the Procedure <br /> Area,Pregnant/Nursing,Eczema/ Psoriasis,Skin Conditions,Allergic Reaction to <br /> Antibiotics,Allergies,Any other medical or skin conditions that may affect the outcome <br /> of your procedure,Ever been prescribed antibiotics prior to dental or surgical <br /> procedures,Currently on any medi cations,History of Cardiac Valve Disease <br /> Any other medical or skin conditions response here: <br /> None <br />