Appointment Type/Request
*
Please Select
Bilateral Tattoo
Left Unilateral Tattoo
Right Unilateral Tattoo
Scar Camouflage
Transgender Tattoo
Eyebrows
Eyeliner
Lips
Medical Consult
Cosmetic Consult
Follow Up Visit
New Student
Pervious Student
Training
What's your name?
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
D.O.B
*
Client Type
*
Please Select
New Client
Pervious Client
New Student
Pervious Student
Referred by? If you were referred by an artist, client, or friend please provide their full name. If you were not referred by anyone please put N/A
*
Scar camouflage follow up questions: What is the scar from? How far post op are you? Have you had any treatments to help the appearance?
*
Training Options:
*
Advanced Paramedical Tattoo Training (must have tattooing experience)
Advanced PMU Cosmetic Tattoo Training (must have tattooing experience)
Fundamental Paramedical Tattoo Training (for beginners)
Fundamental PMU Cosmetic Tattoo Training (for beginners)
Mentorships with Mandy
Shadowing day with Mandy
Other
When will you be ready to attending training
*
ASAP
3-6months
Next year
In the future
Training Goals
*
Referring Plastic Surgeon? If applicable
When did your doctor say you will be ready for tattoo?
*
This question applies to breast tattoos only
How did you hear/find about us?
*
Do you have medical insurance, if so who is the carrier?
Back of insurance card
Front on insurance card
If you are requesting a quote or scar camouflage appointment please submit a photo for the artist to review this will help determine if you are a candidate for tattooing.
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