medical form | Stienevsart

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You can find the consent form for your appointment below. If anything is unclear or you would like to keep me personally informed. Please contact me by email.

Name and last name *

Email address *

Phone number *

I would like to be addressed as *

she
they/them
he
others

I am 18 + (or I have my parent's permission) *

yes
No

I am in good health *

yes
no

I have health problems or discomforts *

yes
no

I have one of the following health problems or discomforts (please inform your tattoo artist about this by email) *

hemophilia, bleeding, or bruising
heart problems
epilepsy
STDs or HIV
Hepatitis A, B or C
I use blood thinners
I quickly get dizzy, nauseous or faint
Others
No

I am allergic to nitrile or latex (or other tattoo related materials) *

yes
no
Others

I am pregnant (in this case you cannot have a tattoo) *

yes
no

I suffer from anxiety attacks, stress or other discomforts and want to let you know for certain reasons *

I have received and understand the aftercare instructions provided to me by the tattoo artist. I agree to follow these instructions carefully to ensure proper healing of the tattoo. *

yes
no

How did I end up with Tattoo Studio Stiene Vs? *

Referred by friends
By passage
Internet - social media
Others

Leave this field empty

Naverzorging Tattoo Stiene Vs Pdf

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After Care Tattoo Stiene Vs Pdf

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