Name *

First Name

Last Name

Phone

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What services are you interested in? *

PLEASE NOTE: Areas I do not tattoo: Palms of hands, Hands/fingers, Ribs, Soles of feet, Private areas that are typically covered. Black + Grey are the only pigment colors I use currently.

Custom Tiny Tattoo Design up to 1-2 inches

Custom Tiny Tattoo Design between 3-5 inches

Not sure

Anyone with any of the following at the time of the appointment CANNOT be accepted for tattoo: *

Younger than 18 years of age Using Accutane or have used Accutane within 1 year from appointment date Freshly tanned/sunburned skin Pregnant/Nursing Viral infections (cold/flu/etc.) or disease If I have diabetes, cancer, heart condition or am currently undergoing treatment for cancer, or on immunosuppressants, I will provide my doctor's approval. I understand that my results may be affected by these conditions

I Agree and Acknowledge