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, we will get back to you in 1-2 business days.

All details about the tattoo will be discussed via email, and a deposit will be required to secure your appointment date. Remember to check your Spam folder to ensure that you don't miss a message from us!

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

*Please note: I work exclusively in black ink (+ sometimes red, upon request).

Thank you!
Your Name

First NameLast Name
Email Address
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Phone Number
Format: (000) 000-0000.
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?
Will this be your first tattoo?
Are you a returning client?
Is this a coverup?
How flexible are you with the design of your tattoo?
Flash Selection

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

NOTE: I will not tattoo designs created by other artists or by AI. 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
NOTE: I will not tattoo the following areas: fingers, feet, neck, face, genitals, butt.
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 centimetres or inches. If unsure, provide an approximation.
Availability
Preferred Days of the Week
Additional Comments/Inquiries (Optional)
I understand that my tattoo will be in black and grey (no colour).
Medical Eligibility — Certain medical conditions, medications, and allergies may complicate the tattooing process. If you are unsure whether your medical condition poses any risks, please consult your doctor before booking.
Please verify that you are human.
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