Medical Questionnaire

Do you have any medical conditions or history of:

• Bloodborne illnesses (e.g., HIV, Hepatitis)?

• Skin conditions (e.g., eczema, psoriasis) in the tattoo area?

• Diabetes, heart conditions, or other chronic conditions?

• Keloid scarring or other healing concerns?

  
  

Acknowledgment and Agreement

By signing below, you confirm the following:

1. I am of legal age for this piercing and have provided a valid government-issued ID as proof. If under 18, a parent or guardian is present and consents to the procedure.

2. I understand the risks associated with body piercings, including the possibility of infection, allergic reactions, scarring, and discomfort.

3. I have disclosed all relevant medical information and understand that failure to do so may increase the risk of complications.

4. I will follow the aftercare instructions provided by my piercer to ensure proper healing. I understand that improper care may result in infection or other complications.

5. I consent to have photos of my piercing taken for the studio’s portfolio, website, and social media. (

6. I release Viper Pit Tattoo Studio and its piercers from liability for any issues that may arise from the piercing, including but not limited to infection, allergic reactions, or dissatisfaction.

Client Declaration

I the client upon signing this declare that I have read and understand the information provided on this form. I have answered all questions truthfully, and I agree to proceed with the piercing under the terms stated above.

CCTV IN OPERATION

For the safety of staff, clients, and studio property, CCTV is in use throughout the premises, including treatment rooms.

• No audio recording is in use.

• Cameras in treatment rooms can be switched off upon request.

• Footage is stored securely for up to 30 days and only accessed by authorized personnel.

• We comply with UK GDPR and Data Protection Act 2018.

By signing below, you acknowledge the use of CCTV and agree to the terms.

Please now pass your device to the member of staff to check, sign and submit your form