Clinical Cosmetic Tattoo Model Application

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

4

Phone Number* This field is required.

Please enter a valid phone number.

5

Date of Birth* This field is required.

Date

6

Have you had previous cosmetic tattoo?If yes, when and where ?

7

Are you comfortable being photographed and filmed for marketing and educational purposes?* This field is required.

YESNO

8

Do you understand that cosmetic tattoo is an artistic procedure and minor natural asymmetries are normal in human faces?

YESNO

9

Have you previously felt dissatisfied with cosmetic or aesthetic procedures?* This field is required.

10

Do you consider yourself highly detail-oriented or perfection-focused?

11

Are you available for both the initial session and a refinement visit (6–8 weeks later)?

YESNO

12

Treatment Interest* This field is required.

Brow Tattoo

Lip Blush Tattoo

Eyeliner Tattoo

Previous cosmetic tattoo cover

13

Photo UploadPlease upload clear, makeup-free photos of the treatment area (front view and close-up).

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

14

Have you had any recent cosmetic or spa treatments (e.g. Botox, lamination, skin peels, lash or brow tinting...etc)? Please provide details.* This field is required.Our team will contact you to guide you through the next steps.

15

Are you currently taking any medications? Please list below if applicable.* This field is required.In some cases, medical clearance may be required. If so, our team will contact you to guide you through the next steps.

16

Do you have any skin conditions such as eczema, dermatitis, psoriasis, or have you experienced any recent severe sunburn? If yes, please provide details.* This field is required.In some cases, medical clearance may be required. If so, our team will contact you to guide you through the next steps.

17

AgreementPlease confirm the following:

I understand full payment is required to secure a model appointment

I understand that all model payments are strictly non-refundable and failure to attend my appointment will result in forfeiture of payment.

I understand selection is not guaranteed.

I understand model investment may vary depending on suitability and media usage.

I understand sessions may take longer than standard appointments.

I confirm I am emotionally comfortable with minor natural asymmetries.

I consent to my photos and video recordings being used for marketing, educational, and promotional purposes across digital and print platforms, including but not limited to websites, social media, online training materials, and advertisements.

I understand that these materials may be published publicly and may remain in circulation indefinitely.

I acknowledge that no additional compensation will be provided for media usage.

18

By submitting this form, you confirm that the information provided is true and complete to the best of your knowledge, and you consent to proceed with the treatment.* This field is required.

YESNO