Consultation Form Legal * First Name Last Name Preferred Name Preferred Pronouns * Date of Birth * MM DD YYYY Email * Phone * (###) ### #### Instagram What service are you interested in? * Flash Tattoo Custom Tattoo Custom Art Explain Your Idea What size, style, placement are you looking for? What is your budget? Less than $100 $150 $200 $300 $400 No Budget Do you have any allergies? (medications, pigments, latex, etc.) Do you have any medical conditions? * (HIV, epilepsy or diabetes, etc.) Are you pregnant or breastfeeding? * Yes No Thank you!
