Freckle Tattoo Consultation Request Form

Name

First NameLast Name

Email

example@example.com

Birth Date

MonthDayYear

What is your skin type? (check all that apply)

Do you have any of the following health or skin concerns - especially in the area being tattooed - that I should be aware of? (Check all that apply)

If other, please explain:

Have you previously had Freckles tattooed?

Did Bethany do your previous Freckles?

If applicable, please describe what makes you unhappy about your current/previous Freckle tattoos.

What goals would you like to achieve for your freckles with this procedure?

What questions do you have regarding this procedure?

Please submit clear photos of your current freckles or freckle inspiration below. If you use henna or makeup regularly for your freckles, please include photos of that as well.