Form
Tattoo Consultation
With Selene Doan
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Are you age 18 or over?
*
Yes, I am
I only tattoo those who are 18+ And will require photo ID at time of appointment ?
*
Yes, I will provide ID at appointment
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Tattoo Consultation
Part 2 - Health Information
Please read carefully. Check all boxes that apply to you.
*
Bruise easily
Scar/keloid scars
Allergic skin - body products/soaps etc
Pregnant/Breastfeeding
NONE OF THE ABOVE
I do need to be aware of certain health conditions and medications.
*
Diabetic
Eczema/psoriasis
Blood thinner
Acutane
NONE OF THE ABOVE/ no health conditions
Other
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Tattoo Consultation
Part 3- Art Information
Is this your first tattoo?
*
Is this tattoo a rework or coverup?
*
What area of the body do you want this tattoo/approximate size (in inches)?
*
Colour or black/grey?
*
Please give a description of what you want tattooed, subject matter, details, any information is helpful.
Ex- if you want flowers tell me if it’s roses or peonies etc
Once I have reviewed your information, I will email you back requesting reference art/tattoos you are inspired by for your piece. I may still need an in person consultation.
Thank you for submitting a request!
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