Name *

First Name

Last Name

Phone *

(###)

###

####

Is this your first tattoo? *

No

Yes

Your availability - select those that best apply *

Note- I work 11-6 Tues/Weds/Fri/Sat (off Sun/Mon/Thurs)

Completely open

Flexible with notice

Tuesdays

Wednesdays

Fridays

Saturdays

All day (10-6)

Mornings only (10-2)

Afternoons only (2-6)

Will this tattoo be going over (or next to) the following?

Scars (over 1 year healed)

An old tattoo I want to cover

A birthmark

Skin condition (Psoriasis, Eczema, etc.)

Next to tattoos I do not want it to cover

Are you allergic to any of the following?

Adhesives

Sharpies

Shellfish

A specific pigment/color

Lidocaine HCL

Have you lost a significant amount of weight resulting in excess skin?

I tattoo ALL body types and only use this information for consideration of the design and how long to schedule for the piece, as it may require more care.

Yes

No

Unsure