COVID 19 REGISTRATION FORM - CUSTOMER
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COVID 19 MEASURES
COVID 19 REGISTRATION FORM - CUSTOMER
COVID 19 REGISTRATION FORM - ARTIST
How do I take care of my tattoo
Contact
STUDIO
KLIN(I)K
Home
Studio
COVID 19 MEASURES
How do I take care of my tattoo
Contact
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 *
Have you been sick because of the Corona-virus *
YES
NO
Have you been in contact with a COVID 19 patient *
YES
NO
Do you have other diseases to report? *
YES
NO
If YES, please specify
Are you over 60 years? Do you belong to a risk group? If so, which one? *
YES
NO
Do you work in the healthcare sector? *
YES
NO
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 our newsletter via email?
YES
NO
Would you like to receive a copy of this registration form (only by email)?
YES
NO
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