New Client Interest Form

Thank you for your interest in our services! Please fill out the form below, and we'll be in touch to discuss availability.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
How did you hear about us?
Referred By:
Please select the city closest to your location:
What type of skin do you have?
What services are you interested in?
📸 Please upload clear photos of the area you’d like treated. (No filters. Good lighting. Area must be visible for proper evaluation.)

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Preferred Appointment

For Restorative Tattoo Inquires

Please will out the questionaries below to provide better consultation services for your appointment.
What area(s) of your body are you hoping to treat?
Please be specific — e.g. lower tummy, hips, thighs, buttocks, breasts, back, arms, knees, or shoulders. You can also include C-section scars, tummy tuck scars, breast lift or augmentation scars, post-liposuction marks, or stretch marks from pregnancy, weight loss, or puberty.
How do your scars or stretch marks affect your confidence or comfort?
You can share how long you’ve had them, how they make you feel, or what you hope to change through this treatment. There’s no wrong answer — this helps me understand your goals and whether the treatment is a good fit.
Are your scars or stretch marks fully healed and over 12 months old?
Have you had any prior treatments on this area?(e.g. laser therapy, microneedling, chemical peels, or anything intended to improve the skin’s appearance.)
If yes, please explain
Are you currently on blood thinners, Accutane, or Retin-A?
Do any of the following apply to you? (Check all that apply)
Please write any questions or concerns we should know about
How would you prefer to be contacted for scheduling and follow-up?
I consent to the use of my documentation including photos, videos, healing updates, and testimonials for marketing, educational, and portfolio purposes. My face will never be shown publicly without my explicit permission.
Signature
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For Restorative Tattoo Inquires