Customer Release Form

GameFace Tattoo

2015 S. ORANGE AVE ORLANDO FL 32806

407-757-0293

Customer Info

Todays Date *

I confirm I am above the age of 18

Yes

No

Parent Signature *

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Notarized Document *

How did you hear about us? *

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Other

First Name *

Last Name *

Phone Number *

Date of birth *

Sex *

Male

Female

Race *

Full Street Address *

Email *

Emergency Contact Info

Emergency Contact Name *

Emergency Contact Number *

Emergency contact Address *

Do you have a bleeding disorder? *

No

Yes

Do you have any allergies or skin conditions *

No

Yes

List of allergies

Is today's appointment for a Tattoo or a Piercing *

Tattoo

Piercing

Do you have a primary care Doctor? *

No

Yes

Dr. Full Name

Dr. Number

Dr. Address

*

I do not have a primary care doctor. incase of an emergency please refer me to: Orlando Health Orlando Regional Medical Center 609 S. ORANGE AVE. ORLANDO FL, 32806

Orlando Health Orlando Regional Medical Center 609 S. ORANGE AVE. ORLANDO FL, 32806

Tattoo/Piercing Description *

Tattoo/Piercing Location *

I confirm that I have been given educational information about my Tattoo/Piercing *

I have been given educational information

*

I UNDERSTAND THAT ALL TATTOO DEPOSITS ARE NON-REFUNDABLE

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Get In Touch

Address: 2015 South Orange Avenue A, Orlando Florida 32806

Email:

Hours of Operation:

Mon - Sat 8am to 6pm

Sunday – Closed

2015 S Orange Ave A, Orlando, FL 32806, USA

Copyright 2024 . All rights reserved

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