CLIENT RECORDS
Please complete this form before your appointment. Required fields are marked *.
Check every condition that applies to you.
If you report one or more of the conditions above, the MDHHS form says you should be encouraged to consult your physician before undergoing a body art procedure.
Open and review both current MDHHS documents before confirming the acknowledgements below. Each opens in a new tab so your form stays here.
On a phone, take a new photo or choose an existing image or PDF from your library or files.
Accepted: JPG, PNG, WEBP, HEIC, HEIF, or PDF. Maximum file size: 8 MB.
I acknowledge that I have received the Disclosure Statement and Notice for Filing Complaints, received the Aftercare Information Sheet, completed the Client Health Questionnaire, and received any additional applicable information. I understand this record serves as signed documentation that the body art facility performing the procedure is a facility licensed by the State of Michigan.
Your completed record and required documents are securely delivered to Blooming Inks and your selected artist. A separate client email will include only your completed Consent PDF and the two official MDHHS documents. If client-copy delivery fails after your record is accepted, the record is preserved and you will be told here.