Medical Disclosure Form

Before we can commence any tattoo work with you, we need to collect some key information, including personal contact information, and relevant medical conditions which may impact on our ability to complete any tattoo work to the standard that both we and yourselves expect.

As a responsible tattoo studio, we want to ensure that not only we deliver exceptional work, but the healing process is not impacted negatively by any medical conditions you have. We of course provide comprehensive aftercare, but there are some things that are best being discussed with your GP / healthcare specialist. We advise that you do this where possible BEFORE deciding to get a tattoo, as the last thing we would want is for you to be disappointed later on down the line.

It is important that you provide honest and accurate answers to these questions, not only to ensure that you are ‘medically fit’ to be tattooed, but also so that we can provide accurate aftercare information and signposting where neccessary. Please pay specific attention to the question pertaining to your date of birth. We retain the right to request ID before commencing any work if we believe that you may be under the age of 18, and we will refuse to provide tattoo services to anyone who can not provide proof of identity / date of birth. You will lose any deposit paid if we discover that you are underage.

All information you provide will remain strictly confidential, and will not be disclosed to any third parties. We are required to retain information on you in case of any future disputes, however all records will be destroyed after 18 calendar months. Because the human body changes over time, you will need to complete this form for any new / future work you have done with us, to ensure that our records are as up to date as possible

This form should take approximately 5 minutes to complete. No data is stored by us until you submit your responses and you receive a confirmation at the bottom of your screen.


    REMINDER: Under UK Law, the legal age for a tattoo is 18. You must be aged 18 or over on the date of your studio time in order to be tattooed. Please bring ID with you to confirm this. If we suspect that you are underage and you can not prove your age, we will NOT tattoo you, and you will lose any deposit paid.


    Medical Conditions

    There are a number of medical conditions that we will need to be aware of before commencing any tattoo work. Having one of these conditions does not automatically mean that we can't tattoo you, but it may be necessary for you to contact your GP / Healthcare specialist for further information and advice before proceeding. In some instances we may ask for an opinion from your GP / Healthcare specialist before agreeing to undertake any work.


    Do you have cardiovascular health conditions? These include the following:

    • Heart valve problems / surgery

    • Angina

    • Irregular heartbeat / arrhythmia

    • High blood pressure / hypertension

    • Previous stroke / heart attack

    YesNo

    Have you had any of the following in the last 3 months?:

    • Major surgery (Requiring inpatient stay)

    • Significant illness requiring hospitalisation

    • Stroke / Other cardiac event

    • Serious viral infection (Including COVID-19)

    • Vaccination (Excluding COVID-19 Booster / Flu Jab)

    YesNo

    If you have answered yes to either of the above questions, please consult your GP / Specialist before your appointment. You may have to adjust your medication doses / delay any tattoo work as per specialist advice. You will be able to reschedule your appointment as necessary.


    Do you have any blood clotting / bleeding disorders? These include:

    • Haemophilia

    • Thrombocytopenia (Low platelets)

    • Fibrinopenia

    • Deep vein thrombosis (DVT)

    • Any other bleeding / clotting disorder

    YesNo

    Do you take any anticoagulant / blood thinning medication? Such as:

    • Warfarin / Dabigatran

    • Apixaban

    • Clopidogrel

    • Rivaroxaban

    • Aspirin (Prescribed)

    YesNo

    If you have answered yes to either of the above questions, please consult your GP / specialist before your appointment, as you may have to lower / stop medication before being tattooed. We can not advise you of this directly, but some medication may increase bleeding & healing time.


    Do you have any neurological conditions?
    Yes - EpilepsyYes - BlackoutsYes - Severe MigranesNo

    Do you have any diabetes or any metabolic conditions?
    Yes - Type 1 / Insulin ControlledYes - Type 2 / Diet ControlledYes - Metabolic conditionsNo

    If you are feeling unwell at any point during your tattoo, please let us know, and your tattooist will be more than happy to let you have a break. Please ensure you can monitor your blood sugars regularly if you are diabetic, and if possible set an alarm on your sensor if your BMs go too high / too low. Poorly managed diabetes can cause infections and may increase healing time.


    Do you currently have / have been diagnosed with any of the following?:

    • Hepatitis A, B, or C

    • HIV / AIDS

    • Syphilis

    • Any other Blood Borne Virus (BBV) or serious infection

    YesNo

    Are you taking medication for any of the following illnesses?:

    • Immunosuppressants

    • Steroids / Corticosteroids

    • Isotretinoin (Roaccutane)

    • Other prescription medication affecting healing / immune functions.

    YesNo

    If you have answered yes to either of the above questions, please consult your GP / specialist before your appointment, as you may have to lower / stop medication before being tattooed. Some medication may increase bleeding & healing time.

    If you have had any BBVs, Hepatitis, or communicable infections, you MUST let us know before treatment. You will normally require evidence that these are in admission, and no longer communicable to others. Failure to inform us may become a police matter in the event of infection / illness towards any of our staff members, and we may need to employ additional safeguarding procedures.


    Do you have have any fibrosis or other scarring disorders?
    YesNo

    Do you have any needle / noise phobias?
    YesNo



    Before pressing the submit button below, please review your answers and check the box to confirm that all answers provided are correct to the best of your knowledge. If you need to amend any answers after submitting, you can do so by emailing us.

    All answers provided are correct to the best of my knowledge. I will inform you of any changes between now & my appointment date.


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