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<br /> SECRET SIDEWALK TAT TO OS <br /> CONSEN T FORM <br /> <br />NAME:____________________________________________DATE______/_______/_______ <br />DATE OF BIRTH:__________________________LICENSE #_____________________________ <br />ADDRESS:______________________________________________CITY __________________ <br />STATE_____________ ZIP___________ PHONE NUMBER:(_________)__________-_________ <br /> <br />I acknowledge by signing this agreement that I have been given <br />the full opportunity to ask any questions which I might have about the <br />obtaining of a tattoo and that all of my questions have been answered <br />to my satisfaction. <br />● If I have any condition that might affect the healing of this tattoo, I will advise my <br />tattoo artist. I am not pregnant or nursing. I am not under the influence of <br />alcohol or drugs. <br />● I do not have medical or a skin condition such as but not limited to: acne, <br />scarring(Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be <br />tattooed that may interfere with said tattoo. If I have any type of infection or rash <br />anywhere on my body, I will advise my artist. <br />● I acknowledge it is not reasonably possible for the representatives and employees <br />of this tattoo shop to determine whether I might have an allergic reaction to the <br />pigments or processes used in my tattoo, and I agree to accept the risk that such a <br />reaction is possible. <br />● I’ve been informed that currently the ink used in my tattoo is not FDA approved <br />and health consequences are unknown. <br />● I acknowledge that infection is always possible as a result of the obtaining of a <br />tattoo, particularly if I do not take proper care of my tattoo. I have received <br />aftercare instructions and I agree to follow them while my tattoo is healing. I <br />agree that any touch-up work needed, due to my negligence, will be done at my <br />own expense. <br /> <br />