Neri Ramirez

Medical Consent & Release Form


Today's Date: September 8, 2026

PLEASE CHECK ANY CONDITIONS BELOW THAT APPLY TO YOU:

Medical Conditions

Do you have any allergies? Please Describe: 

List any medications you are currently taking:

Are there any other known MEDICAL CONDITIONS or CONTAGIOUS DISEASES that may affect your tattoo procedure? Please Describe:

Please re-enter your name and email address below, then click the signature box to legally e-sign this consent form.

Leave this empty:

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Signature Certificate
Document name: Medical Consent & Release Form
lock iconUnique Document ID: 7d6cbc8f60711b7caef3976287efbdede80330b3
TimestampAudit
November 10, 2020 10:37 PM PDTMedical Consent & Release Form Uploaded by Neri Ramirez - hello@neriramirez.com IP 99.42.0.63