Blackbird Tattoo Studio

Please be aware we only accept cash or bank transfer.

Artist*

Appointment Date*

First Name*

Last Name*

Date of Birth*

Phone Number

Email Address*

Procedure*

Have you previously experienced or are experiencing any of the following:

Skin disorders, such as Psoriasis, Eczema, Acne, Impetigo, Dermatitis

Heart conditions, such as Angina, Heart disease, Congenital heart problems

Immune system disorders, such as Hepatitis, HIV, AIDS

Blood disorders, such as Haemophilia, High blood pressure, Diabetes

Seizures, Epilepsy, Fainting, Dizzy spells

Allergies to Nickel, Alcohol

Bulimia

Psychiatric disroders

Pregnancy or breast feeding

Do you take blood thinning medication such as Asparin, Warfarin

Have you taken any alcohol or drugs in the last 24 hours

Any other medical condition or information you feel we should know about

Terms:

I fully understand the piercing procedure and its consequential implications.

I fully understand the correct aftercare advice that i have been given. I realise that if I do not comply with this advice an infection may occur. I understand that this is unrelated to the piercing procedure and I cannot hold the piercer responsible.

I acknowledge the piercing procedure has been fully explained to me and I fully understand that over a period of time after the piercing has been carried out (this time will depend on the part of the body pierced) the jewellery inserted in the piercing may begin to work its way out to the surface of the skin and eventually come out alltogether leaving a scar and require a new piercing procedure. Therefore I understand that I may be left with scarring in due course.

I confirm that I am willing to undergo the piercing procedure to realise that any scarring so caused is at my own risk.

I understand that the position of the piercing will be marked with a dot and agreed with me before the piercing is carried out.

I acknowledge that the piercing is carried out at my own risk and Blackbird Studio cannot be held responsible for any problems caused directly or indirectly as a result of this piercing.

I therefore give consent for Blackbird Studio to pierce me with a disposable piercing needle and to insert a piece of jewellery into the piercing.

The medical history that I have given is correct to the best of my knowledge and I understand that by not declaring everything I may be putting my health at serious risk.

I agree to any photographs taken of my piercing to be used by Blackbird Studio as they deem fit and appropriate and understand that the image rights belong to Blackbird Studio solely.

All personal data will be kept in compliance with the GDPR data protection policy.