Custom Tattoo Request Form

Name
Legal Name if Different
Pronouns
Date of Birth
Name

First NameLast Name
Email
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred mode of contact (phone or email)
Have you been tattooed by me before?
Is this a cover-up
Tattoo Placement
Specific placement (multiple is fine if you aren't sure where!)
Tattoo Size
Please guess size in cm or inches (ex: 3in by 4in)
Description
Any and all details about the design you would like me to know!
If there is a cover-up involved, please take a well-lit photo of the tattoo that you would like covered as well as some area around it
Cover up photo:

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Any idea/reference photos may be included below
Reference 1

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Reference 2

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Reference 3

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Preferred time of appointment:
Inquiries and additional comments:
Once your request is approved you will be contacted with further appointment details.

Thank you!
Should be Empty:

Any idea/reference photos may be included below