Lumith Tattoo - Request Form

Name*

FirstLast

Email*

Phone number*

Tell me what you're thinking.*

What’s the concept, meaning, or feeling you want the tattoo to carry? Even if it’s loose, go ahead and share.(Pinterest link optional!)

Where's it going?*

I don't tattoo hands, fingers, feet, toes, ears, or faces.These areas often heal unpredictably, fade quickly, and distort with time.If it won’t age well, I won’t place it there.

Rough Size?*

in inches, or just describe what you're picturing. You can use household items or body parts

Upload reference images (it should allow for multiple)*

These don’t need to be perfect—tattoos, artwork, textures, or anything that helps show the direction you're drawn to.

Upload a photo of the placement area on yourself

Natural light is best. This helps with size, orientation, and design flow.

My minimum cost is $175 & My hourly rate is $175/hr

Do you have a rough budget range in mind?

This helps me design within your comfort zone - I can scale sizes, detail, and placement that fit your range.

I understand the $175 minimum applies to all bookings*

🚫 If you have any of the following, please consult with your doctor before making an appointment:

Blood clotting disorders, Immune disorders, Uncontrolled diabetes, Keloid scarring tendency, Severe Eczema, Psoriasis, Dermatitis, Epilepsy, Heart conditions requiring antibiotics before any procedures, or Active cancer or chemo/radiation.

🚫 If you are taking any of these listed medications, please consult with your doctor before making an appointment:

Accutane, Steroids, Immunosuppressants, Antibiotics, Plavix, Warfarin, and Xarelto.

Any allergies or other medical conditions I should know about?

Note any allergies, medications, or skin conditions that could affect your tattoo

Which skin tone best represents the area that you're getting tattooed? (please refer to the image)*

How did you find me?

Instagram / Google / Referral / Other

I understand that submitting this form doesn’t guarantee an appointment, and that if I’m approved, a non-refundable deposit will be required to book.*

Once you hit submit, you’ll be redirected to the appointment calendar.