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Permenant Jewellery Consent Form

Please take a minute to fill in the following information prior to your appointment.

Birthday
How did you hear about us?
Do you have any of the following medical conditions?

Please read and tick the following statements if you agree.

Acknowledgement

I completed the above form to the best of my knowledge. I have had the opportunity to ask any questions and have received satisfactory answers. I understand the risks and potential side effects associated with the permanent jewellery procedure. I understand that the results of the procedure are not guaranteed and may vary from person to person. I am over the age of 16 and consent to the procedure. If I am under the age of 16, a parent or guardian must sign. I will not hold the technician / jeweller, or employees liable for any issues not disclosed at the time of my service or any adverse effects from the permanent jewellery procedure. This agreement remains in effect for this procedure and any follow-up appointments.

Date
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