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Falling Angel Tattoos (18 & Over Consent Form)

18 & Over Piercing Consent Form
(Print Page, Fill It Out & Take It With You To FALLING ANGEL TATTOO)

656 Suffolk Avenue
Brentwood, N.Y. 11784
(631) 922-8078

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I,______________________________________________, D.O.B._______________________
have contracted with FALLING ANGEL TATTOOS on the date below to pierce the following part(s) of my body: ______________________________________________.
I understand that there are certain risks associated with having the above part of my body pierced & that if I am having a piercing of mucus membrane tissue (specifically tongue, nipple, & genital area) that the risk can be of an invasive infection, and that I assume sole responsibility of those risks, and that should an infection develop that medical attention may be necessary.
I understand & agree to follow the recommended after care given to me by FALLING ANGEL TATTOOS.
I agree not to hold FALLING ANGEL TATTOOS &/or its employees, or any promoter or person(s) who provide space to FALLING ANGEL TATTOOS liable in any manner for any problems arising from having the above procedure performed.
I state that I am over the age of 18 and that I am not under the influence of any drugs &/or alcohol, and that I have informed FALLING ANGEL TATTOOS of any medical conditions that I may have:
Prescription Medication:______________________________,
Heart Condition:____________________________________,
Diabetes:__________________________________________,
Allergies to:________________________________________,
Communicable Diseases:______________________________,
Other:_____________________________________________

Signature:_____________________________________Date:____/____/____
Piercer:________________________________Amount: $ ___________.____

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