Bamboogoo has collaborated with a licensed pharmacist to bring you the safest, most effective compounded numbing products we can formulate.This form provides us with important information about you, your health and your upcoming tattoo, so we can supply responsibly.Use this simple form to purchase your Bamboogoo+ Numbing Foam!*The information collected on this form is purely for our pharmacist's records. They won't be shared with anyone, and you won't be added to any mailing lists!

We need the following information to legally dispense your Bamboogoo+ Numbing Foam. Please select how you want to receive the topical anaesthetic.

Patient Medical History

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LEAF PHARMACY PTY LTD (Licensed Pharmacy) Registration Number P5244
ACN 668887652