Purpose of your visit
(required)
TATTOO
PIERCING
Full Name
(required)
Email
(required)
Phone
(required)
Date of Birth
(required)
Do you have any existing health conditions allergies or medical issues?
(required)
YES
NO
Text
Todays Date (YYYY-MM-DD)
(required)
By submitting this form, I confirm that I am 18 years old or older and acknowledge that various factors can impact the outcome of the tattoo or piercing. I take full responsibility for ensuring the proper healing and protection of the tattoo or piercing and pledge to adhere to the aftercare instructions provided.
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