Tattoo removal appointment request – Ink Is Art Tattoo Lounge & Laser Tattoo Removal

Name *

First

Last

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

What side of the body

What are you looking to do

Please check if any apply

I have Rash/eczema/psoriasis in/around tattoo area
I am Under a dr/physicians care for any medical reasons
I will be going on a trip sun/camping/cottage/travelling
I am diabetic
I have allergies/skin sensitivity to vaseline/soap/disinfectant/antibacterial agents, tape, cosmetics, nitrile, or snything hospital related that should be of concern before we begin!

Please list any medications you are currently taking

Where on your body/body part description

Please include a photo of the tattoo in its current state

Click or drag files to this area to upload. You can upload up to 4 files.

Please no selfies, please fet the photo taken by someone else - from 2-3 feet away with bright light on the tattoo area.