Name * First Name Last Name Date of birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Verify Email* * Date * MM DD YYYY Seizures (such as epilepsy)? * Yes No Suffers from any heart conditions? * Yes No Blood pressure problems? * Yes No Haemophilia or any other blood disorder? * Yes No HIV or other immune compromising condition? * Yes No Hepatitis A, B, C or D? * Yes No Suffers from Diabetes or Lupus? * Yes No Skin conditions (such as Eczema or Psoriasis)? * Yes No Any allergies to latex, plasters, metals, iodine, creams? Yes No Any allergies to latex, plasters, metals, iodine, creams? * Yes No Are you prone to fainting or dizzy spells? * Yes No Are you taking any blood thinning medication? Yes No Have you consumed any alcohol or drugs in the past 24 hours? * Yes No Any known/previous reaction to dye pigments? * Yes No Artist * Alba Guido Valentina Martina Teo Ollie Guest Artist Price * Deposit * £50 £100 None You're all set for your tattoo, darling! Just one last thing… Every now and then, I’ll send a sweet little note with studio news or special treats nothing pesky, just Nana things. Yes, please! I love Nana surprises. No, thank you my dear, maybe another time. Thank you!You are wonderful Consent form
