Lip Tattoo Consent Form
Please complete this form to provide your consent and important information prior to your lip tattoo procedure.
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Have you previously had a lip tattoo procedure?
*
Yes
No
Are you currently taking any medications or have any allergies we should be aware of?
Preferred Appointment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit Consent
Submit Consent
Should be Empty: