Returning Selina Medina Clients

1

Full Name* This field is required.Please use your preferred name

First Name

Last Name

2

Phone Number* This field is required.You will receive a text message about your tattoo appointments...

3

E-mail* This field is required.Give us your email if you would like to sign up for newsletters

4

Would you get tattooed at a tattoo convention?* This field is required.Tattoo conventions take us all over the world, would you want to get tattooed at a public event?

YESNO

5

Is this tattoo a coverup?* This field is required.

YESNO

6

Are you trying to complete tattoo work already started by Selina?* This field is required.

YESNO

7

Description of your tattoo:* This field is required.Please include scale of work

8

Attach photos of inspiration for your tattoo here:

Drag and drop files here

Select files to upload

Max. file size: 4.9MB

Accepted file formats: GIF, JPG and PNG

9

Additional Comments/Questions:

If you have additional questions or comments, let us know here.

10

Selina and Matt work very hard to be in contact with every person who wants to be tattooed, however some people fall through the cracks. We appreciate patience and grace as we are small business owners who offer a quality tattoo service. Please understand not all timing that works for you will work with our availability, when we offer appointments that is what we have open. Selina predominantly tattoos in Charlotte, NC we encourage you to consider travel to get the tattoo you truly want. If you cannot travel please feel free to add your name to the waiting list for travel tattoo appointment opportunities.* This field is required.Do you understand that adding your name to the waiting list means you will be contacted in order of opportunity to get tattooed? This may mean travel is needed to get tattooed.

YESNO