This form is for customers with an existing booking. For tattoo enquiries please fill out the enquiry form Step 1 of 3 - Client Details 33% Unique IDArtist Name*NoemiLizOtherArtist Variable*Artist*Tattoo Body Part*Name* First Last Email* Enter Email Confirm Email Full NamePhone*Are you over 18?*YesNoDate of birth* Date Format: YYYY dash MM dash DD Address* Street Address City County / State / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country ID Type*ID CardDriving LicensePassportID Number* Client medical historyDo you currently suffer from, or have you ever suffered from any of the following?Do you have the capacity to make your own informed decisions?*YesNoHeart Condition/Angina*YesNoDescription*Blood Pressure Problems*YesNoDescription*Epilepsy/Seizures*YesNoDescription*Haemophilia/Blood Clotting Disorders*YesNoDescription*Blood borne Virus, e.g. Hepatitis B/C or HIV*YesNoDescription*Skin Complaints, e.g. psoriasis, eczema, dermatitis*YesNoDescription*Diabetes*YesNoDescription*Allergic Response, e.g. anaesthetics, jewellery*YesNoDescription*Are you prone to fainting attacks?*YesNoDescription*Do you regularly take any blood-thinning medicines, e.g. aspirin?*YesNoDescription*Do you take any regularly prescribed medication?*YesNoDescription*Are you, or could you be pregnant?*YesNoDescription*Are you breast feeding?*YesNoAre you Vegan?*YesNoHave you experienced any Covid-19 related symptoms in the past 14 days?*YesNoDescription*Have you had the recent onset of a new continuous cough?*YesNoDescription*Do you have a high temperature?*YesNoDescription*Have you noticed a loss of, or change in, normal sense of taste or smell?*YesNoDescription*Have you read and understood the printed guidelines R.E: COVID-19?*YesNoCovid19Description* How did you hear about us?Do you consent for us to film and take pictures for our social media?*YesNoTerms*I agree that it is my responsibility to read this and follow the aftercare advice given until the treatment area is healed. I give consent to the operator to retain the details provided on this form for a minimum period of two years from today. I agree to the Terms of Service Almost there!Hit submit and you will be redirected to digitally sign the consent form
