Name*

Email*

Phone*

How would you like to be contacted?*
EmailPhone

Where is the tattoo located?*

What is your skin type? How does your skin react in the sun?*
Type I - white, fair skin, red/blonde, blue eyes, freckles - Always burnsType II - white, fair skin, red/blonde, blue/green/hazel eyes - Often burns, tans with difficultyType III - White or olive skin, any eye color - sometimes mild burns, tans easilyType IV - brown/Mediterranean descent- rarely burns, tans with easeType V - dark brown/middle eastern descent - very rarely burns, tans very easilyType VI - black- Never burns

How many years have you had the tattoo?*

What color(s) of ink are the tattoo?*

Has your tattoo been covered up?*
YesNo

Have you had any tattoo removal treatments before?*
YesNo

Is there anything else you think we should know?

Please upload a photo of your tattoo. (2mb max size, PNG, JPG, JPEG, GIF)*