Body Art Adverse Event Form
Report any complications or adverse reactions related to body art procedures. Please provide as much detail as possible to help us understand and address the incident.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Date of Adverse Event
*
-
Month
-
Day
Year
Date
Type of Body Art Procedure
*
Please Select
Tattoo
Piercing
Microblading
Permanent Makeup
Other
Location of Procedure (Studio/Shop Name & Address)
*
Describe the Adverse Event or Complication
*
Symptoms Experienced
*
Redness
Swelling
Pain
Fever
Discharge
Rash
Other
Actions Taken After Event
*
Cleaned the area
Applied ointment
Visited a healthcare provider
Took medication
Other
Did you seek medical attention?
*
Yes
No
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