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Piercing Consent Form

Client Information

Birth Date
Month
Day
Year

Pre-Procedure Questionnaire

Are you in the influence of drugs or alcohol?
Yes
No
FEMALE ONLY: Are you pregnant or nursing?
Yes
No
Do you have a infectious disease?
Yes
No
Do you have any skin conditions?
Yes
No

If yes, please identify the condition.

If yes, please identify the following.

Acknowledgement & Waiver

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3/F LDR Bldg. Project 4, Quezon City

Philippines, 1109

 

©2018 by Crimson River

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