Touch up appointment request Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneWhat side of the bodyRightLeftPlease check if any applyI have Rash/eczema/psoriasis in/around tattoo areaI am Under a dr/physicians care for any medical reasonsI will be going on a trip sun/camping/cottage/travellingI am diabeticI 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 takingWhere on your body/body part description How long ago where you tattooed0-3 months4-12 monthsGreater than 1 yearIf your tattoo is less that 4 months old - an appointment will be booked for after that time, as the tattoo needs to be fully healed before i touch up- If a touch up is required due to imperfections in application- the touch upmwill be free within 1 year, Touch ups requested due to fading/damages from improper aftercare adherence will be subjected to the hourly rate $180 per hourPlease include a photo of 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. Submit