Body Tattoo Request Form

Body Tattoo Request Form
Please fill out this form to the best of your ability. If you're having any difficulty completing this form, please contact viecoolstudio@gmail.com.
Client Information
Name*

First NameLast Name
Age*
This service is only available to guests of 18+ years old.
Date of Birth*

MonthDayYear
Please enter a valid date.
Phone Number*
Example: (000) 000-0000Format: (000) 000-0000.
Email*
example@example.com
Pronouns

Appointment Details
Flash - Initial appointmentFlash - Touch upCustom - Initial appointmentCustom - Touch up
If booking for a flash, please include the design reference(s)*
Example: EF1
Please upload a picture of the desired design*

If booking for a flash, you can upload a screenshot of the design.
Cancelof
If booking for a custom, please add a description of the design
Add as many details as possible
Desired placement*
Indicate your desired placement for the tattoo(s)
Desired size*
Indicate your desired size for the tattoo(s)
YesNo

Existing Conditions
YesNo
What are the medications you are currently taking and what is their purpose?
YesNo
YesNo
Please list down your allergies below (e.g. latex, tattoo ink of a certain colour, alcohol, etc.)
YesNo
YesNo

Please check below if you have the following medical conditions:*

Rows	Yes	No	Remarks
Cancer
Hyperpigmentation
Keloid
Hemophilia
Diabetes
Hepatitis
Tuberculosis
Epilepsy
Anemia
HIV positive
Heart conditions (including pacemaker)
Auto-Immune condition
Venereal disease
Asthma
Iron deficiency anemia
Radiation therapy or chemotherapy
Glaucoma
Skin disorder (including rashes, eczema, infection, psoriasis)
Organ transplant
Other

Google searchFacebookWord of mouthInstagramReferral from one of my previous clientsOther
I understand that submitting this form isn't an appointment confirmation. The studio will review my booking request and if the appointment is confirmed, I will receive an email confirmation.
Should be Empty:

Existing Conditions