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Tattooing <br /> 12. 1 will disclose any information of hemophilia or bleeding disorders- <br /> 119303 ( )2 <br /> 13. 1 will disclose any history of cardiac valve disease-119303 (b)2 <br /> 14. Current medications you are on? -119303 (b)3 <br /> 15. 1 will disclose all requirements antibiotics prior to surgery or <br /> dental procedures-119303 <br /> 16. 1 will disclose any other risk for blood borne pathogens- <br /> 119303 (b)4 <br /> 17. 1 agree to assume the risk of possible injury, allergic reaction or <br /> disease that may occur as a result of this procedure Y / <br /> 1 . This procedure on your skin is permanent, is that ok with you? <br /> -119303 (a) 3 Y / <br /> 19. 1 understand the success of my Tattoo depends not only upon the <br /> skill of the technician, but upon the aftercare I give myself. Upon <br /> receiving written and oral instructions on my tattoos aftercare from <br /> the technician and leave the shop, I am fully responsible for it's care. <br /> Y / N <br /> 20. 1 understand that healing time vary from person to person Y J <br />