Date |
Time |
Appointment |
Description |
Size |
ARTIST |
Deposit |
Total |
Are you 18 or older ? |
Age |
Name |
Surname |
Date of birth |
ID number |
Email |
Phone |
Address |
Parent's Name |
Parent's Surname |
Parent's Date of birth |
Parent's ID number |
Parent's Email |
Parent's Phone |
Parent's Address |
Permission |
Parent signature |
Any heart condition: |
Allergies to: anesthetics, adhesive plaster, jewellery or latex? |
Are you pregnant or breastfeeding? |
Are you taking any blood or medication as Warfarin, Aspirin etc? |
Please list any current medications/treatments from the hospital |
How did you hear about us? |
How did you hear about us? :: other |
Customer signature |
GDPR Agreement |
send aftercare email |
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