Paramedical Tattoo Booking Form
Paramedical tattooing (3D effect Areola/Nipple tattoos) will take place at Alter Studio in Warrenpoint by Rosemary McKevitt. We will be in contact as soon as possible after receiving your form
I require Areola and Nipple tattooing due to -
*
Mastectomy
Cosmetic surgery (Uplift, Reduction etc)
Gynecomastia Surgery
Gender reassignment surgery
No surgery, just correcting a colour imbalance
Other
If 'Other' please provide a brief description
Have you had a nipple graft?
*
Yes
No
Back
Next
Do you require unilateral or bilateral tattooing?
*
Unilateral (I need one to match the other side)
Bilateral (I need to create the effect on both sides)
Back
Next
Has more than 6 months passed since your last surgery or cancer treatment? This includes radiotherapy, chemotherapy and reconstruction)
*
Yes
No
Not applicable
Back
Next
Do you require us to tattoo directly over scarring?
*
No
Yes, my scar is under 12 months old
Yes, my scar is more than 12 months matured
I'm not sure
Back
Next
Do you have any current medical conditions or treatment plans that could impact your healing process?
*
No
Yes
If yes, please provide details. We will require you to have confirmation from your healthcare provider that it is safe for you be tattooed
Have you ever experienced Keloid or Hypertrophic scarring?
*
Yes
No
I don't know
Back
Next
How soon are you hoping to have your paramedical tattoos?
*
As soon as possible
Within 3 months
Within 6 months
In more than 6 months
Back
Next
Are you eligible for Bupa private healthcare coverage of micro-pigmentation?
*
Yes
No
If you are getting paramedical tattooing due to Mastectomy, can your Consultant provide a referral to us for you to have Areola and Nipple tattoos? (This is will not effect your eligibility in any way)
*
Yes
No
I don't know
Back
Next
Are you a local client or overseas?
*
I am based within 2 hours of Warrenpoint
I am based more than 2 hours away
I live overseas and will be travelling
If we can accommodate your tattoo request, would you prefer an in person consultation before booking? (Recommended)
*
No - book the tattoo appointment online as soon as possible
Yes - consultation first, I’ll book my appointment in person
Back
Next
Name
*
First Name
Last Name
Email
*
example@example.com
Date of birth (over 18’s only - photographic I.D required at your appointment)
*
-
Month
-
Day
Year
Date
Feel free to share any relevant information or questions here
Back
Next
Submit
Should be Empty: