Tattoo Intake Form
Hello there 🫶

Following the completion of this form, I will reach out to you with further details.

Please allow up to 24-72 hour response time.
First and Last name *
D.O.B*
What type of service are you interested in? *
Tiny Tattoo
Lip Blush/Tattoo
Combobrows (nanohair strokes + machine shading)
Shaded Powder Brows
Are you currently pregnant or nursing?*
Pregnant
Nursing
Neither
Is your skin dry or oily?
Dry
Oily
Please list any current medications you are on including blood thinners, or medication that may increase bleeding, as well as vitamins (type NA if none) *
Please check any of the following conditions that apply*
Blood Clots
Eczema
HIV/AIDS
Asthma
Cancer/Chemotherapy
Hepatitis (A-D)
Epilepsy
Fungal Issues
Prone to Cold Sores
High/Low Blood Pressure
Lupus
Herpes
Warts
Thyroid Condition
Vertigo
Psoriasis
Dermatitis
Rosacea
Keratosis pilaris
Hemophilia
Skin Allergies
Please provide a clear photo of the specific area on your body where you would like to have tattooed? This will help me better understand your preferance, please list if your right or left *
Choose a file
The THSS regulations requires tattoo shop to keep a copy of client ID to verify that client is if legal age. (18+) kindly submit a photo copy of your ID*