DOB *
DOB
Phone *
Phone
Are you HIV Positive? *
Do you have hepatitis? *
Are you hemophiliac? *
Are you prone to fainting? *
Are you pregnant? *
Have you consumed alcohol in the past 8 hours? *
Are you an intravenous drug user? *
Do you have any allergies? *
Are you epileptic? (do you have seizures?) *
Are you taking any medications? *
Do you have low blood sugar? *
If you have answered YES to any of these questions, please alert your artist.
What type of piercing do you want? *
How did you find us? *