Tattoo and Piercing Consent Form Are you pregnant? YesNo Are you breastfeeding? YesNo Do you have epilepsy? YesNo Do you have HIV/AIDS? YesNo Do you have diabetes? YesNo Do you have hepatitis? YesNo Do you have skin deformations or scars? YesNo Do you have heart or circulatory problems? YesNo Do you have chronic diseases? YesNo Do you have any alergies? YesNo Signature This form uses Akismet to reduce spam. Learn how your data is processed. Δ