2026 APPOINTMENT REQUEST FORM

JESS GROZA TATTOOS

MORTAL EMBLEM TATTOO3333 SE BELMONT ST. PORTLAND, OR
^{My name is Jess and I am a second gen Filipino American currently working at Mortal Emblem in Portland, OR. I’ve been tattooing since 2022. I am also a licensed advanced esthetician certified in Areola Restoration Tattoo and Velvet Lip Blush Tattoo. I’m happy to work in black and gray or color! I’d love to work with you!}
Some things that I love to tattoo:
- Traditional/Neo Traditional
- Illustrative Botanical (including fruit/veg and their flowers/foliage)
- Script (old english, cursive, simple text)
- Coverups
- Cute Shit!
- Cats
- Ladies/Lady Heads
- Hands Holding Things
- Clowns
- Hearts
- Insects, Birds, Butterflies, Worms, Frogs
- Velvet Lip Blush
- Areola Restoration
  If you’re not sure if your project is something I’d like to work on, please fill out my form anyways, I’d still love to hear from you.
Pronouns
PREFERRED NAME

First NameLast Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
IS THIS YOUR FIRST TATTOO?
APPOINTMENT TYPE
If while filling out this form, the questions do not apply becasue you are booking for Velvet Lip Blush or Areola Restoration, please type N/A.
TATTOO STYLE
Black and Grey or Color?
PLACEMENT
Knee, Shin, Forearm, Left, Right, Lips - please be as specific as you can.
Optional

Please upload a photo of the area you would like to have tattooed. If there are any other tattoos surrounding the area, this will help me with drawing the design to fit the area. If this is a cover up, please take a photo of the tattoo or scar as straight on as possible.
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TATTOO SIZE
Your best estimate in inches or palm size, half sleeve, full back works as well!
DO YOU HAVE A BUDGET YOU NEED TO WORK WITHIN?
My minimum price for a tattoo is $100 but I will make some exceptions for smaller pieces. I'm happy to work within a reasonable budget.
PLEASE DESCRIBE YOUR TATTOO IDEA AS DETAILED AS POSSIBLE
If you are booking for Lip Blush or Areola Restoration please type N/A
REFERENCE PHOTO

Please upload at least three reference photos to help me get a better idea of what you are looking to get. I am a visual leaner so this really helps me!
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HAVE I TATTOOED YOU IN THE PAST?
Preferred Appointment Days
What date and time work best for you?
ADDITIONAL DATES
Just in case someone swoops up your first preferred date, please list at least three more dates that would work for you
WOULD YOU LIKE TO BE NOTIFIED OF EVENTS OR PROMOTIONS?
Once I receive your form, I will reach out to you within 1-3 days to confirm your appointment date and get any other additional information I may need from you. Once we confirm the date, I require a $100 deposit to hold your appointment date. This deposit is non refundable. If you need to reschedule your appointment, please give me at least a 72 hours notice.

Thank you for your interest!

XO,

Jess
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JESS GROZA TATTOOS