Scarring, Pigmentation & Paramedical tattooing Form

This form is for tattooing over and around: various surgeries, burns, birthmarks, disfigurement, amputation, acne scars, keloids, etc. *Please only use this form for such.

I realize how big of a deal it is to do this, and I’m excited for you. Thank you for including me and taking the time to share your story through this form. The more information I have, the better I can help you and/or point you in the right direction in regards to tattooing.

*If you’re looking for color tattooing to blend scarring colors and camouflage, please specify. I don’t do these, but we have a tattooer that specializes in burns.

Please Read before submitting form…

  1. Tattoos must be a minimum of one year after your most recent injury or surgery. We can book up to six months in advance, so if the timing works, please submit!

  2. PHOTOS - After you submit this form, please email photos of yourself to - Use your name as the subject of the email. One straight on photos of your healed self, and another one from a slightly turned view. You’re welcome to include any other photos you deem relevant as well. We realize how vulnerable and odd it feels to send these photos. Be assured we take this seriously and confidentially. Being able to see your scarring or discolorations helps the entire process.

  3. Pricing is based on time. At $500 an hour, a usual day of tattooing is between 3-6 hours. The majority of work can take place in one full day. Occasionally a large piece will take two days (Once accepted, a deposit is required to secure the appointment)

Name *
Date of most recent injury/surgery
Date of most recent injury/surgery
*if applicable
Can you briefly describe the cause of your injury/procedure/surgery? Or give us detail on skin condition, discoloration, etc.
Use this space to include any other personal information you'd like for me to know about you! (not required)
Cell phone
Cell phone
You'll probably have to cater to my schedule, but we try to help. What days of the week (M-F) are best for you?
Experience *
Do you have other tattoos?
Will you be traveling to me in Chicago? If so where will you be coming from?
What imagery do you want as a tattoo? Scarring limits this as we tend to stick to organic imagery (as to trick the eye) but we are open as well.