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ROOTED BODY LLC CONSENT FORM

Please take your time filling out this form with the most recent and accurate information possible. Thank you!

Contact Information

Emergency Contact Info

Medical History

Have you ever had a tattoo before?
Are you currently pregnant?
Are you currently under the influence of alcohol or drugs, prescribed or otherwise?
Have you ever had or do you currenty have any of the following:
By checking each box you agree to the following:
Upload/Take Photo
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