About
Recent Work
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Policy
Reservation
R
eservation
C
onsent Form
Name
Email
Phone Number
Are you 18+ years old?
Yes
Do you have any medical conditions such as hepatitis, heart disease, diabetes, high blood pressure, keloid scarring, eczema, psoriasis, or allergies that might affect the tattoo procedure or its healing process?
YES. I do.
NO. I do not.
If Yes, Please explain.
If you are pregnant, breastfeeding, or currently taking antibiotics, I regret to inform you that I am unable to proceed with the tattoo at this time.
Placement
Please be specific.
Tattoo Size
Description
Reference
You can attach multiple photo
Browse Files
Drag and drop files here.
Preferred days of the week
Tuesday
Wednesday
Thursday
Friday
Saturday
If you are looking for a specific date, please list below those dates, so I can try to accommodate you.
Have you been tattooed by me before?
YES
NO
I agree to
Terms and Conditions
Submit