Consent Form

Touched by the Arts Tattoo Studios

Consent Form

First name*

Last name*

Birthday*

Phone*

Email

Procedure Date*

Description and Location on the Body where the Tattoo will be done.*

Are you under the influence of drugs or alcohol?*

FEMALE ONLY: Are you pregnant or nursing?

Do you have a communicable disease?*

Do you have any skin conditions?*

Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)

If yes, please identify the condition.

Email*

Phone*

I consent to receive notifications via SMS

Yes, subscribe me to your newsletter.

SOCIAL

CONTACT

Tel: (904) 684 5294

8106 Old Kings Rd S

Ste 3, Jacksonville, FL 32217

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