Tattoo Request Form

1. Contact Information

Full name

Phone

2. Your Tattoo

Tell me about your tattoo.

Describe your idea, preferred symbols, visual direction, and any meaning or story you would like the design to hold.

Approximate Size

Please provide the approximate width and height in inches.

Example: Approximately 2 × 3 inches.

Reference or Inspiration Images (Optional)

Your reference image will be used for inspiration only. Another artist’s work will not be copied directly.

What best describes your design direction?

I have an idea and would like JINDHAMMA to create an original design.

I created the design myself.

Another artist created the design for me, and I have permission to have it tattooed.

I am sharing reference or AI-generated images and would like JINDHAMMA to reinterpret them.

I confirm that any design or image I submit is my own, used with permission, or provided only as a reference. I understand that JINDHAMMA does not reproduce another artist’s work or a reference image exactly.

I understand that minor adjustments may be necessary to improve placement, readability, and how the tattoo ages over time.

Are there any elements of your design that you would like to keep unchanged?

Enter “None” if you are open to minor adjustments.

Placement Area

Please describe where you would like the tattoo placed.

Placement Photo

Please upload a clear photo of the area you would like tattooed. This helps me evaluate placement, size, and body flow.

Requested Service

3. Appointment Availability

Please select your preferred available date and time.

Aug - Sep 2026

Week starting Sunday, August 30

Time zone: Coordinated Universal Time (UTC)Business location

Saturday, Sep 5

10:00 AM - 11:00 AM

11:00 AM - 12:00 PM

12:00 PM - 1:00 PM

1:00 PM - 2:00 PM

Your selection is a request only. Your appointment is confirmed only after your request has been accepted and you have received written confirmation from JINDHAMMA.

4. Health Information Consent

JINDHAMMA may collect consumer health data you provide, including relevant health or skin conditions, medications, allergies or sensitivities, current illness or infection, healing or scarring history, and pregnancy or breastfeeding status.

This information is collected and used to evaluate tattoo safety, appointment timing, and appropriate bandage or aftercare options. It may be processed on JINDHAMMA’s behalf by Wix and service providers used for email communication and secure record storage, or disclosed when required by law.

JINDHAMMA does not sell consumer health data or use it for advertising. You may withdraw consent from future collection or sharing by emailing ink@jindhamma.com. Without information necessary for safety screening, JINDHAMMA may be unable to evaluate or provide the requested service.

Please review the Consumer Health Data Privacy Policy.

I consent to JINDHAMMA collecting and using my consumer health data for the purposes described above.

5. Health and Safety

Is there anything about your health, skin, medications, allergies, current illness, or healing or scarring history that could affect tattooing or aftercare?

Yes

I’m not sure

Examples include a condition or medication affecting bleeding, immunity, or healing; antibiotics; an active illness or infection; irritated or affected skin at the placement area; adhesive, latex, nickel, pigment, or skincare sensitivities; or a history of raised scars or keloids.

Health Details

Briefly describe only the information relevant to tattoo safety and healing. If you are unsure whether it is safe for you to be tattooed due to a medical condition or medication, please consult your healthcare provider before your appointment can be confirmed.

JINDHAMMA does not provide medical advice and may require written medical clearance.

Enter “None” if there is nothing further to add.

Do not stop taking or change any prescribed medication without guidance from your healthcare provider.

Are You Currently Pregnant or Breastfeeding?

Yes

JINDHAMMA does not provide tattoo services during pregnancy or breastfeeding.

6. Additional Information

Is there anything else you would like me to know?(Optional)

You may share accessibility needs, previous tattoo experiences, a tendency to feel faint, or anything that may help me provide a safe and comfortable experience.

7. Confirmation

I confirm that I am at least 18 years old and understand that valid, unexpired government-issued photo ID is required before tattooing.

I confirm that the information provided is complete and accurate to the best of my knowledge.

I understand that submitting this form does not guarantee acceptance, reserve a time, or confirm an appointment.

I have reviewed the Preparation and Aftercare instructions.

I have read and agree to the Studio Policies and Terms of Use.

I acknowledge that I have had access to the Privacy Policy and Consumer Health Data Privacy Policy.

Begin Your Request

Each request is reviewed personally. You will receive a response within 1–3 business days. Please check your spam or junk folder if you do not see a reply.

Tattoo Request Form

Begin Your Request

Each request is reviewed personally. You will receive a response within 1–3 business days. Please check your spam or junk folder if you do not see a reply.

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Before submitting your request, please review: