REGISTRATION FORM - CUSTOMER | kliniktattooshop.be

Name and last name *
 E-mail *
 Phone number *
 Age + parent's approval (only to be completed if you are a minor / minimum 17 years young)
 Write here the name of your artist + date of appointment *
 I am in good health * YES
 NO
 I have hemophilia, bleeding, or bruising. * YES
 NO
 I have heart problems or epilepsy. * YES
 NO
 I have high or low blood pressure. * YES
 NO
 I have STDs or HIV. * YES
 NO
 I have Hepatitis A, B or C. * YES
 NO
 I am allergic. * YES
 NO
 I use blood thinners. * YES
 NO
 I am pregnant and / or breastfeeding. * YES
 NO
 I quickly get dizzy, nauseous or faint. * YES
 NO
 How did I end up at Studio Klinik? * Referred by friends
 By passage.
 Via internet - social media.
 Others.
 Can we keep this data for our customer base? YES
 NO
 Would you like to receive a copy of this registration form (only by email)? YES
 NO
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