Appointment Form
To request an appointment, please fill out the form below.
Appointment Request
Please Select A Date and Time That You’d Prefer
Please note my availability is every weekday!(weekends upon special request!)
Are you at least 18 years of age (State law requires you must be 18 to be tattoed)
*
Yes
No
Name
*
First Name
Last Name
Pronouns
They/Them, She/Her, He/Him, etc
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Instagram username
Best method for contacting you?
*
Please Select
Email
Instagram
Best time of day to reach you?
*
Please Select
Morning
Noon
Afternoon
Evening
Night
Any time
Black and Grey or Color?
*
Please describe the Tattoo Concept, Placement, and Size (in inches)…And/Or Please describe the piercing you are requesting for
*
Would you like to request a Silent Chair Session ?? (This is an option for those who don't like small talk and would prefer as little conversation as possible during their appointment.)
Yes
No
Are you aware that this is ONLY a request and if I have the date and time available you will be reached directly for confirmation
*
Yes
No
Yes, I’ll reach out on instagram as well
Any other Information you feel may be important such as if you need to request a weekend date for your appointment (or you can leave me a dad joke for fun…)
Reference Photo #1
*
Browse Files
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Choose a file
Don't forget to tell us what you like most about this. Style, position etc.
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of
Reference photo 2
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Choose a file
Don't forget to tell us what you like most about this. Style, position etc.
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of
Reference photo 3
Browse Files
Drag and drop files here
Choose a file
Don't forget to tell us what you like most about this. Style, position etc.
Cancel
of
Submit
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