Consultation form

Fill carefully. You will sign on the next step. Under 18 cannot continue.

Staff walk-in: enter the customer’s email (not yours). Their account is created if needed; they can OTP later to view the form.

Checking session…

Your details

Name

Date of birth

Stored as a calendar date (no timezone shift).

Address

Postcode

Phone

Email

1. Have any known/previous reactions to dye pigments

Yes No

2. Suffer from any known allergic responses (e.g. plastic, creams, metals, iodine, shellfish, latex, food-stuff, others)

Yes No

3. Suffers from haemophilia / other clotting disorders

Yes No

4. Consumed alcohol or drugs in the last 24 hours

Yes No

5. Prone to fainting attacks

Yes No

6. Is the client pregnant

Yes No

7. Eaten in the last 4 hours

Yes No

8. Are you over the age of 18

Yes No

9. Are you happy with the design that has been presented to you

Yes No

10. Do you currently have AIDS, HIV, Hepatitis A/B/C or any other blood-borne diseases

Yes No

Anything else the artist should know?

I am aware that it is my duty to submit truthful information

Records kept for studio use. Sensitive health information — do not share login codes.