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Pale moon tattoo2/14/2023 ![]() If I am pregnant or nursing, I have advised my tattoo artist. If I have any conditions such as, but not limited to: diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS, or any other communicable disease, heart condition, or take medicine which thins the blood, I have advised my tattoo artist. I acknowledge I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. Madison, WI 53703 First Name: Last Name: Street Address: City: State: Zip: Email: Driver’s License/ID Number: Driver’s License/ID State: Date of Birth:īy signing this consent form, I agree to its terms.
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