Tattoo Request Form - Witherbloom Tattoo

Tattoo Request Form

All information supplied below is confidential and for professional use only.
A tattoo request form must be submitted before an appointment can be made. Once your form has been received, we will discuss the details of your tattoo, including pricing, via email.

Be sure to familiarize yourself with our Studio Policies and FAQ 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
Where will you be travelling from?*

Street Address

Street Address Line 2

CityProvince / State

Zip Code
Are you inquiring about a Flash (pre-made) design or a Custom design?*

FlashCustom
Is this your first tattoo?*

YesNo
Are you a returning client?*

YesNo
Is this a coverup?*

YesNo
How flexible are you with the design of your tattoo?*

Very flexible; I’d like to let the artist do their thing.Slightly flexible; I would like to retain some elements from my concept.I am looking for a very specific design.
Flash Selection*

Please include a screenshot of the flash design you are interested in.
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Design Description*
Please explain your design idea. Be sure to mention specific elements you’d like included, as well as the overall look/style (linework, photorealism, fine line, script, dotwork, etc.)
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.
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Body Placement*
List the placement(s) you are considering. Make note of any scars, moles, or other skin conditions on the area. NOTE: I will not tattoo the following: head, neck, hands, fingers, genitals, feet.
Body Placement Photos (Optional)

Include a few clear and well-lit photos of the area of your body being tattooed. (Optional)
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Tattoo Size*
W x H in centimeters or inches. If unsure, provide an approximation.
How soon would you like to get a tattoo?*

As soon as possible.In the next 1-2 months.No preference.Other
Availability*

I'm flexibleWeekdaysWeekends
Preferred Days of the Week

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Additional Comments/Inquiries (Optional)
Please verify that you are human*
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