Tattoo Request Form - Witherbloom Tattoo

Tattoo Request Form

All information supplied below is confidential and for professional use only.
Welcome! Please submit your tattoo idea below.

Once your form has been received, all details about the tattoo will be discussed via email, and a deposit will be required to secure your appointment date.

Be sure to familiarize yourself with our FAQ and Studio Policies before submitting a tattoo request form.

*Please note: I work exclusively in black and grey.

Thank you!
Your Name*

First NameLast Name
Email Address*
Date of Birth*

MonthDayYear
Phone Number*
Format: (000) 000-0000.
Where will you be travelling from?*

Street Address

Street Address Line 2

CityProvince / State

Zip Code
FlashCustom
YesNo
YesNo
YesNo
Very flexible; I'd like to let the artist do their thing.Slightly flexible; I'm open to the artist making some changes to the design.I am looking for a very specific design.
Flash Selection*

Please include a screenshot of the flash design you are interested in.
Cancelof
Design Description*
Design Reference Photos

NOTE: I will not tattoo designs created by other artists. Designs found online can be used as inspiration for a custom piece, but we will work to transform it into something new and unique to you.
Cancelof
Body Placement*
NOTE: I will not tattoo the following: hands, fingers, feet, head, neck, genitals.
Body Placement Photos (Optional)

Include a few clear and well-lit photos of the area of your body being tattooed. (Optional)
Cancelof
Tattoo Size*
W x H in centimetres or inches. If unsure, provide an approximation.
I'm flexibleWeekdaysWeekends
MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Additional Comments/Inquiries (Optional)
I understand.
Please verify that you are human.*
Should be Empty: