I Heart Tattoos Inc. Consent Form

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1745 Victoria Street, Prince George BC, V2L 2L6.
250-564-1250
www.ihearttattoos.ca

Email *

About you.

Personal information is collected for our health records.

I am of the age 19 years or older. *

Please have you Government Issued ID out for us to verify your health records. We no longer require a photocopy, but we do require to verify everyone's ID with their consent form.

Yes

I am in good health and free of symptoms due to sickness and in co-ordinance with the current Public Health Order. *

Yes

First and Last Name *

Phone Number *

Date of Birth *

YYYY

Address *

Email Address

We do not send spam.

Are you taking any blood thinners? *

Yes

I am not under the influence of any alcohol, drugs or any intoxicating substances at the time the tattoo is being administered. I understand that my artist or another staff member will ask me to leave if they feel I was untruthful, whether my tattoo is complete or not. *

Yes, I am NOT under the influence.

No, I am intoxicated.

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