TATTOO REQUEST FORM

MISSISSIPPI INK TATTOO BOOKING REQUEST

21 Bridge Street, Carleton Place, Ontario
Thanks for your interest in getting a tattoo at Mississippi Ink! We do our best to offer an authentic and comfortable tattoo experience in a setting that is both classic and inviting.

Please take the time to fill out all of the information in this request form. Notify us of any relevant information about the tattoo, the placement, the size, and your skin or any conditions you may have. If there is anything you do not understand, please outline it in the "Questions" section at the end. We look forward to hearing about your next tattoo!

There will be two sections: The first is for your tattoo and the second is details for your appointment. Please fill both out to the best of your ability.

Note: We require deposits to hold appointment dates.
Your Tattoo

Please answer these basic questions followed by details about your tattoo.
Preferred Name*

First NameLast Name
Are you over 18 years old? (Persons under 18 require a Parent or Legal Guardian Signature)*

YesNo
Email*
example@example.com
Phone number
Not required, we will probably never phone you
Please select the option that best describes what you are looking for*

Custom TattooFlash Tattoo (Pre-Made Designs)Half Day Session (Dalton Only)Full Day Session (Dalton Only)Cover-Up / Repair / Fix Old TattooSleeve Project (We will request a consultation)
Placement*
(forearm, calf, etc. Be specific.)
Tattoo Size (Approximate)*
Please state size in inches
Please select the amount of time that best describes how long you typically sit for*

Hour or Less1 - 2 Hours2 - 4 hours4 - 6+ hoursUncertain
Which Artist are you making this appoint with? (Instagram handles beside names)*

Dalton R (@dalt.rabb.tattoo)Emilie L (@missemilietattoos)No Preference
Are you looking for colour, black and grey, mix, or unsure? (Note: Not all artists do colour tattoos)*

ColourBlack and GreyMixUnsure
Description of the Tattoo. We will request reference images when we contact you back.*
Any and all details I could need to know
PREFERRED DAYS OF THE WEEK*

MONDAY (Emilie only)TUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAYSUNDAY (Emilie only)
PREFERRED START TIME*

Early (11am-2pm)Late (3pm-6pm
We try to get all clients in as soon as possible. What time frame are you hoping to get this tattoo in?*

As soon as possible1-2 months2-4 months4-6 months6+ months (why even wait that long?)
QUESTIONS & ADDITIONAL COMMENTS ABOUT THE TATTOO
Tell Us About Yourself

In this section, please answer honestly about yourself and how we can make this appointment as comfortable for you as possible.
IS THIS A FIRST TATTOO?*

YesNo
ARE YOU AN EXISTING CLIENT?*

YesNo
Unfortunately we do have one step up from the sidewalk. DO YOU REQUIRE WHEELCHAIR ACCESIBILITY OR ACCESS?*

YesNo
ARE YOU SOMEONE WHO PREFERS A PRIVATE SIT? (Some individuals have anxiety in settings with many people and we are committed to making your tattoo a comfortable experience)*

YesNo
Do you have any skin conditions or scars on the area you want tattooed? Please answer in detail with any questions or concerns.
Do you have any other conditions (low blood pressure, chronic pain, sciatica, epilepsy, etc) that may be relevant to the tattoo?
DO YOU HAVE AN ALLERGY TO LATEX?*

YesNoUnsure
DO YOU INTEND ON USING A NUMBING CREAM OR SPRAY?

YesNoUnsure
Please use this box to let us know if there is anything we can do to make your experience more enjoyable. For example, loud music or no music, or any fears or phobias.
Please use this box if you have any other questions or concerns about the tattoo process, our equipment, our studio location, accessibility, parking, etc.
I understand that this booking request form does not guarantee me an appointment. I understand that I will be contacted for follow up via email within 5 business days. I understand that if I make changes to my design after submitting this request and booking the appointment the cost may vary from the quote I was given.
THANK YOU!

We are looking forward to your next tattoo with us!
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MISSISSIPPI INK TATTOO BOOKING REQUEST

Your Tattoo

Tell Us About Yourself

THANK YOU!