Tattooer

  • - select tattooer -
  • Ashley Thomas
  • Desiree Keys
  • Alejandro Ramirez
  • Craig Roberts
- select tattooer -
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Upload state issued ID...
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Your First Name
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Your Last Name
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Appointment Date
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Your E-mail Address
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Date of Birth
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Drivers License #
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Issuing State
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Expiration Date
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Your Phone Number
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Your Address
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I acknowledge that by signing this agreement that I have been given ample opportunity to ask any and all questions which I might have about the process of obtaining a tattoo and that all questions have been answered to my full satisfaction. I specifically acknowledge that I have been informed of the facts and matters outlined below and I agree as follows:
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I have read the above information and understand that this is a legally binding document, and that by signing I agree to and am bound by its terms.
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Your First Name
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Your Last Name
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Date Signed
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SALT LAKE COUNTY REASONABLE NOTIFICATION COMPLIANCE SECTION

Please answer Yes or No to all of the following questions and sign below. By signing this form you are acknowledging that you have been reasonably informed of the inherent risks involved in the tattoo processes and procedures in accordance with Salt Lake County law, and release Echelon Tattoo and Echelon Creative, Inc. from any and all responsibility associated with said processes and procedures. Article 4.2.5. sections iii-iv from Salt Lake Valley Health Department Body Art Facilities Regulation:
a. Has your date of birth has been verified from a valid, government issued photo identification?
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b. Have you disclosed any known allergies to latex, iodine, or other products routinely used in a body art procedure?
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c. Have you ingested blood thinners such as aspirin or ibuprofen within 24 hours prior to receiving a body art procedure?
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d. Have you consumed alcohol or other intoxicants within 24 hours prior to receiving a body art procedure?
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e. Do you have a condition that might a ect the procedure or healing process such as lupus, diabetes, or hemophilia, etc?
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(iv) Are you aware of risks associated with body art procedures such as the risk of fainting, vomiting, and infection including bacterial endocarditis for patrons with a heart condition?
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I have read and understand the above information and understand that this is a legally binding document, and that by signing I agree to and am bound by its terms.
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Printed Name
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Date Signed
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