Appointment Request Form

Tattoo Request Form

Chelsea Brazzo / @dirtylittlepaws_
Preferred Name*
Name*

First NameLast Name
Prounouns*
Phone*
E-mail*
Have you been tattooed by Chelsea before?*

Yes!Nope, I'm a new client
Are you interested in flash, or commissioning a design?*

Flash (pre-made design)Custom design
What would you like to get tattooed? For custom designs, please be as descriptive as possible and include any styles that apply (ex: black and gray, American traditional, etc). If you have references, please save them until you are contacted via email about booking!*
Where on your body would you like your tattoo to be placed, and approx. how large would you like it to be (ex: upper right thigh, 4x6”)?*
What is your budget for this piece? *Please list either an exact amount or a range in dollars*, and note whether or not your budget is flexible (ex: $400-500, flexible). For custom designs, a flat quote will be given based on a combination of your budget and her sliding scale rate of $175-200/hr. A $100 non-refundable deposit is required to set and hold your appointment, which will be deducted from the final cost of your tattoo. If you need to reschedule your appointment with less than 72 hours notice, the previous deposit will be forfeited, and you will be asked to place a second, larger ($150) deposit in order to book again (the second deposit will then be deducted from the final cost of the tattoo).*
Ex: $200-500, flexible
Are you 18 years of age or older?*

YesNo
Are you local to Portland, OR? If not, where will you be traveling from?*
What days work best for you?*

WednesdayThursdayFridaySaturdaySunday
What time works best for you?*

12pm - 3 pm (afternoon)3pm - 6pm (evening)12pm - 6pm (all day)
Should be Empty:

Tattoo Request Form