**TATTOO REQUEST FORM**

WWW.FKSEGISMUNDO.COM/FLASH

** ONLY BOOKING MAY & JUNE 2021**

NAME *

First Name Last Name

PRONOUNS

EMAIL *

example@example.com

PHONE NUMBER *

Area Code Phone Number

YOUR INSTAGRAM

TRAVEL BOOKING? *

Yes No

WHICH CITY? *

ARE YOU A NYC LOCAL? *

Yes No

WHERE ARE YOU BASED? *

WILL YOU TRAVEL VIA PERSONAL CAR? *

Yes No

TYPE OF TATTOO *

Flash

FLASH SERIES *

Movements Birth Marks Skin Graft Versicolour Monochrome Senses Markings Beauty Spots

COLOUR *

Black? Teal? Burnt orange? Bright magenta? It’s entirely up to you!

PLACEMENT *

Where would you like the tattoo? Please specify which side.

FILE UPLOAD *

Upload photo

NOTE: for flash: upload screenshot of design.

NOTES

Additional information e.g. booking date preferences

IDEAL TIME FRAME *

SELECT DATE AND TIME SLOT:

Please understand this is subject to change based on flash selected, other requests and time it'll take for me to execute your tattoo. Weekend slots are limited, but can be discussed further to accommodate - please state your preference in the notes above.

ADDITIONAL INFORMATION

IS THIS YOUR FIRST TATTOO? *

Yes No

DO YOU HAVE ANY SKIN CONDITIONS? *

Yes No

IF YES, PLEASE DESCRIBE

This is important for me to know so that I can work with it

DO YOU REQUIRE A COLOUR TEST? *

Yes No

COVID Acknowledgement:

Please read carefully

I,   First Name*   Last Name* , acknowledge to take the COVID-19 PCR test a few days prior to my appointment with Frances Segismundo. I also acknowledge to schedule my COVID test accordingly to obtain the results in time to show proof before my appointment with Frances Segismundo.

I,   First Name*   Last Name* , will notify Frances Segismundo if we need to reschedule my appointment due to a positive result.
Signature*   Date*

NOTE:

Tattoo pricing varies from project to project.

In order to reserve the design and secure your appointment with me, have your Venmo ready to submit a deposit. Information will be provided.

FLASH TATTOO REQUEST FORM