Tattoo inquiry form
Please fill out the form below to request an appointment, I will reach out to you within 1-3 days. I specialize in floral, script, black and grey, fineline, custom designs. Please feel free to add multiple reference photos for custom designs
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
What tattoo would you like to get? Please provide as much detail as possible
Provide reference photos if possible (does not have to be exact just an idea)
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Placement of tattoo
Face/neck/head
Shoulder/chest/upper back
Back/lower back /stomach
Legs/ankles/foot
Arms/hands
Other
If other, please provide in detail
*budget range* My minimum is $150. Budgets help determine size, detail, and placement
$150 (small/flash)
$170-$300
$300-$500
$500-$800
$900+ (X large/multiple sessions)
Other
Do you have any of the following medical conditions? (Check all that apply)
Pregnant or breastfeeding
Recent illness or fever
Recent surgery or injury near where the tattoo would be
Any Allergies (latex, metals, adhesive, ink, etc.)
Active skin infection
bleeding disorders (hemophilia, clotting disorders)
diabetes
heart condition
epilepsy or seizure disorder
autoimmune disorder
HIV/AIDS
hepatitis
cancer or recent chemotherapy
Anemia
poor circulation
keloid scarring
psoriasis or eczema
Chronic skin conditions or rashes
Other
Are you currently taking any medications or under the influence ? (Check all that apply)
Accutane/isotretinoin
Blood thinners
Antibiotics
Steroids immunosuppressant
Insulin or diabetic medication
Recreational drugs
Client acknowledgment
I confirm that the information provided above is accurate and complete to the best of my knowledge. I understand that disclosure of a medical condition does not automatically disqualify me from being tattooed, and that a doctor’s clearance may be required at the artist’s discretion. I acknowledge that withholding medical information may increase the risk of complications.
Preferred day and time frame for appointment / extra notes or questions
Once I review your request I will reach out to you via Preferred contact method (please provide below)
Text
Email
Social media
Other
Phone number
Email
Social media/ other
Thank you! Please submit, I’m looking forward to tattooing you:)
-bootat2
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