Name *

(preferred)

First Name

Last Name

Are you booking for a handpoke tattoo or machine? *

*if booking for machine, please note that I tattoo flash or custom botanicals only.

Handpoke

Machine

Handpoke/machine combo

Unsure

Flash or Custom? *

Please note: I no longer allow anyone to reserve flash designs ahead of time, you much choose at your appointment. I will have a few albums of artwork for you to view at your session, and I’m always willing to adjust/edit a design to your liking so I’m sure we can find something you’ll love!

Pre-drawn flash

Custom idea

Do you need a sliding scale payment option? *

I am anti-capitalist and really want to remain accessible for everyone, while also making enough to survive off of this practice and keep My Place open. I do NOT want any proof or explanation from you, but please do NOT check yes below if you can easily afford food+housing, make more than minimum wage, are an able-bodied white person, or if you have a family capable of financially helping you when needed. These are all privileges that should allow you to be able to save up enough money to pay my standard price. I work with budgets and give price estimates ahead of time, so you can take your time and save up if needed.

Yes

No

Have you been tattooed by me before? *

Yes

No

I have read and reviewed the ‘Booking Information’ page prior to submitting this form.

I am 18+

I will wear a mask at all times during our tattoo session.

I will reschedule my tattoo appointment if I develop any Covid-related symptoms or if I’ve been in contact with someone who tested positive.

I will arrive to my tattoo session hydrated, having eaten, and completely sober from drugs or alcohol.

I understand that failure to abide by these boundaries will cause my tattoo session to be cancelled and my deposit forfeited.