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Consultation Form

How do you wish to be contacted?
Are you 18 years old or older?
Are you pregnant?
Yes (or maybe)
No
Are you breastfeeding?
No
Yes. My baby is exclusively breastfeed
Yes. My baby also takes formula or eats solids
Do you have or previously had any of the following: (Please check all that apply)
Have you ever been diagnosed/treated for any type of cancer
*The following medical conditions require a note from your doctor giving consent (select if applicable):
I have previously had tattoo/s performed by SOMEONE ELSE on the same area that I am asking to work on in this session.
YES
NO

If “YES” on previous question you understand that correcting or touching up tattoo/s that were performed by others involves additional risks because of the existence of permanent pigments or ink of unknown composition, brand, color, age, shape and other factors over which we have no control. Additional appointments after the initial appointment may be required and will be billed at our standard rates.

You understand that results can't be predicted in advance and cannot be guaranteed and has not represented that the results will be as you desire. You understand and fully accept the risks associated with this procedure and hold Laura Charleston and anyone in her team harmless from same.

AT THE STUDIO? 

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