Name *

First Name

Last Name

In order to be allowed entry, you must check all the boxes below. *

I have not exhibited symptoms of COVID-19 in the two weeks prior to my appointment?

I have not tested positive for COVID-19 within the last two weeks?

I agree to wear an appropriate face covering while waiting outside of the tattoo studio as well as my duration inside the studio.

I am not bringing anyone but myself into the tattoo studio.

Appointment Date *

MM

DD

YYYY

Appointment Time *

Hour

Minute

Second

AM PM