I acknowledge that I am aware certain medical conditions and treatments and/or medications used to treat those medical conditions may be adversely impacted by the procedure(s) of tattooing and/or body piercing and/or branding. Such medical conditions include but are not limited to, impaired kidney and/or liver function, diabetes, jaundice, medication con- taining blood thinners and medications that weaken the immune system.
I further acknowledge that the tattoo and/or brand should be considered permanent; that said tattoo and/or brand can only be removed with a surgical procedure; and that any effective removal may leave permanent scarring and disfigurement.
I have read this form and confirm that all the information I have given is correct. I understand that this is a consent form and I agree to be legally bound by it.
Today's Date: June 15, 2021