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Indemnity Form

Name *

First

Last

Your Birthday Date *

Cell Number *

Email *

What are you getting done? *

Who is your Artist? *

Facebook and or Instagram handles *

May we use pictures of you and/or piercing on social media? *

Yes!
No

May we use your social media details, and contact details to market our promotions and news to you in future? *

Yes!
No

The Consortium takes no responsibility for any harm that comes to you, the client due to not sharing truthful health information that could help us give you the best experience and healing period possible. *

I Agree!

Are you HIV positive? *

Yes
No

Are you Hepatitis B/C positive? *

Yes
No

Do you faint easily? *

Yes
No

Do you have heart problems? *

Yes
No

Do you have epilepsy? *

Yes
No

Do you have very high or low blood sugar? *

Yes
No

Do you have very low blood pressure? *

Yes
No

Are you a diabetic? *

Yes
No

Are you on blood thinning medications? *

Yes
No

Do you have any allergies? *

Yes
No

Do you consider yourself COVID safe to be in the studio? *

Yes
No

Have you had something to eat today? *

Yes
No

Have you had Grandpa or Disprin or effervescent tablets last night or today? (Or any Blood thinning medication) *

Yes
No

Do we need to know anything about your medical status?

I hereby allow The Consortium to do a tattoo/piercing procedure on my body, and set The Consortium free of any responsibility of complications due to my withholding information or not adhering to their aftercare rules. *

I Agree

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