Please complete this form in full to request a tattoo appointment.

Please allow 48 hours for a reply and check junk and spam folders.

For any general enquiries please contact us via email to welcome@heartbreaksocialclub.com

We also accept walk-ins on a first come first served basis if we have space on the day.

Name

First Name

Last Name

Phone

(###)

###

####

I confirm I am 18 years or older

Yes

Date Of Birth

Artist

If an artist's name is not in the drop down menu, they are currently not taking bookings. If you are getting matching tattoos with one or more people, please only submit one request form and let us know in the additional comments how many people it's for.

Tattoo Description

Colour or Black & Grey

Please ensure you select the correct option as not all artists do colour work.

Colour

Black & Grey

Tattoo Size

Please measure in centimetres. It is very important this is accurate to be able to book you in.

Tattoo Placement

What part of the body and what side?

Preferred days or dates (If any)

Please include alternative dates in case your first choice is not available

Additional Comments:

Picture References - Please provide references for all tattoos with tattoo idea and tattoo style preferred if possible (6 max)

FileField;MaxSize=5120;Multiple;addText=Upload_Images;