Custom Tattoo Request
This form is for requesting custom tattoos only. Please see the Flash Tattoo Request form to inquire about flash designs. To inquire about multiple custom designs, please send one form per each design.
Full Name
*
First Name
Last Name
Pronouns
*
Birthday
*
-
Month
-
Day
Year
Date
E-mail
*
example@example.com
(Not required) Phone Number
Format: (000) 000-0000.
(Not required) Instagram @
Are you fully vaccinated against COVID-19?
*
Yes
No
Have you been outside Ontario in the past two weeks?
*
Yes
No
Are you experiencing any of the following symptoms?
*
Cough
Fever
Runny nose and/or sneezing
Sore throat
Loss of taste or smell
Shortness of breath
Nausea and vomiting
Upset stomach
None :)
Are you currently taking any acne medications, blood thinners, or antibiotics?
*
Acne medication
Antibiotics
Blood thinners
none
Have you taken medication for acne, such as Accutane, within the past year?
*
yes
no
If you answered yes to the question above, what is the name of the medication?
This is to ensure whether or not a tattoo is safe for you at this time. Most acne medications (as well as some antibiotics and blood-thinners) can affect your body's ability to heal a tattoo, even up to a year after treatment.
Tattoo information
Is this your first tattoo?
*
No
Yes
I have machine tattoos, but this is my first hand poked tattoo
Describe the custom design you are looking for. Be as specific and detailed as you can.
*
Approximate size of the tattoo
*
Possible placement(s) of the tattoo
*
Attach reference photos here
*
Browse Files
Drag and drop files here
Choose a file
Please do not use another tattoo artist's work as reference. Provide as many examples as you feel is necessary.
Cancel
of
Do you have a budget/price range in mind?
*
Yes
No
Approximate price range (if applicable)
What days work best for you?
*
Tuesday
Wednesday
Thursday
Saturday
Sunday
No preference
What time works best for you?
*
12pm
1pm
2pm
No preference
I understand there is a $35 non-refundable deposit per each custom design
*
Yes
Any questions?
Anything else you think I should know?
Any special requests?
Submit
Should be Empty: