Release form

Fill this release form out in its entirety to the best of your abilities.

You

Legal first name

Legal last name

Age

Date of birth

Phone

Street address

City

State

ZIP

Emergency contact — name and phone number

Photograph the front of your driver license or government photo ID. This picture is stored on the PDF.

Take or choose photo

Procedure

Date

Placement

Artist

Description

Check anything that applies. The artist may decline the procedure.

Medications, allergies, or details

Scroll the box to read it. You can skip to the signature.

Signature — I have read and agree to this release in its entirety