Book Appointment

LASER TATTOO REMOVAL

Appointment Request Form & Deposit

* Indicates required field

Name (First & Last) *

Email *

Phone *

Date Of Birth ex. xx/xx/xxxx *

Tattoo Size *

Treatment Package *

Select Skin Type *

We require a $100 non-refundable deposit to setup and hold an appointment. The deposit comes off the total cost of your Laser Tattoo Removal Package. I Agree that I am Depositing $100 to secure a Laser Tattoo Removal Treatment and Consultation *

Deposit Amount *

Please take a clear well lit photo 8 to 10 inches away
with either a camera or cell phone of the tattoo that
you want removed. Upload photo in the link below.

Upload Photo of Tattoo *

Max file size: 20MB

Request Day of Appointment ex. xx/xx/xxx *

Payment Type *

Card Number *

Name on Card ( First and Last ) *

Exp. Date ex. xx/xx *

CVV *

Billing Zip Code *

Any other information you would like us to know? *

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LASER TATTOO REMOVAL

​Appointment Request Form & Deposit

Appointment Request Form & Deposit