Tattoo Request Form

Tattoo Request Form

Booking for February & March 2026

Pricing: $65 minimum or $85/hr before tax
Personal Information
Name*

First NameLast Name
Email Address*
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth *

MonthDayYear
You must be 18 years old to get a tattoo in the state of Iowa regardless of parental consent. You do not need to be 18 at the time of submitting this form, but you must be on the day of your appointment.
Are you pregnant or nursing? If so, I cannot tattoo you.*

YesNo
Are you booking for yourself or a group session?
If booking for a group session, you only need to fill out one form. Please provide the following information for each person receiving a tattoo: First & Last Name, Email Address, and Date of Birth.
Tattoo Information
Approximate Tattoo Size*
Please estimate size in inches (1-2", 2-3", 3-4", etc.)
Tattoo Placement*
(Ex: forearm, upper arm, calf, thigh, etc.)
Black or Colored Ink*
If you would like color, please state what color you would like. I only offer color as solid line work or as a pop of color.
Type of Tattoo

CustomTouch UpFlash
Description of tattoo(s)*
Please describe with as much detail as you can the tattoo(s) you are wanting to get. If booking for a group, please provide details for each persons tattoo. If requesting birth flowers, please specify the birth flower month and type. If requesting lettering, please specify font type (cursive, typewriter, sans serif, etc.).
Inspiration/Reference Photos

Please upload all of your inspiration photos for each tattoo being requested. You can upload multiple photo to the box above. These photos are typically used as inspiration and do not need to be an exact replica of the tattoo(s) you are wanting to get.
Cancelof
What days and times work best for you for your appointment?*

Wednesday Morning (9AM-12PM)Wednesday Afternoon (1PM-4PM)Wednesday Evening (5PM-8PM)Friday Morning (9AM-12PM)Friday Afternoon (1PM-4PM)Saturday Morning (9AM-12PM)Saturday Afternoon (1PM-4PM)
Is there anything else you would like me to know?
Additional Scheduling Requests, Inquiries or Comments
Thank you so much for your interest in getting a tattoo done by me! Please be sure your form is filled out with as detailed as possible as this will allow me to get back to you quicker with a price estimate and appointment times.
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Tattoo Request Form

Personal Information

Tattoo Information