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Day
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Birthday
Month
Day
Year

Please read the waiver below.

Please check "yes" or "no" for the following questions.

I am 18 years old or older.
Do you have diffulty stopping bleeding (clotting)?
Are you pregnant?
Do you have any communicable diseases? (Hepatitis B or C, HIV/AIDS, etc.)
Have you been jaundice in the last 10 days? (Yellow skin or eyes)
Do you take blood thinners?
Do you have heart related problems?
Do you have high blood pressure?
Do you have diabetes?
Are you prone to fainting?
Do you have any known allergies?
Are you under the influence of any drugs or alcohol?
Have you eaten in the last 2 hours?
Have you taken any anticoagulants (ibuprofen, Asprin. etc.) in the last 24 hours?
Do you have any conditions that may affect the healing of your tattoo?

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