Consent Form - Makayla Walker Tattoos - REAP

Full Name*

Your full legal name

Date of Birth*

Must be 18 years or older

Phone Number*

Your mobile phone number

Email Address*

Your email address

Address*

Your full address including postcode

Have you consumed alcohol in the last 8 hours?*

YESNO

Are you under the influence of drugs?*

YESNO

Have you taken aspirin, ibuprofen or blood thinners in the last 24 hours?*

YESNO

Do you have a latex allergy?*

YESNO

Are you pregnant or breastfeeding?*

YESNO

Are you prone to fainting?*

YESNO

Do you have any other allergies?*

Please list any other allergies or sensitivities

Do you have any other conditions that might affect the healing of this tattoo?*

Please describe any medical conditions, medications, or other factors

License/ ID number*

Digital Signature*

By signing below, you acknowledge that you have read and agree to all terms above and that all information provided is accurate

Please sign above

Tattoo Consent Form