Client Intake Form — Harvey Dickson Tattoo

Full name *

Email *

Phone *

Date of birth *

You must be 18+ to book.

Instagram / portfolio you'd like to reference (optional)

Placement area *

Specific placement notes

Size *

Small (up to ~3in) — symbol, word, minimal design Medium (~3–6in) — single-subject piece Large (~6–12in) — half sleeve section, thigh, back panel Extra Large (12in+) — full sleeve, full back, full leg Not sure yet

Exact dimensions (if known)

Style *

Select all that apply — many pieces blend styles.

Color Realism Black & Grey Realism Traditional / Old School Neo-Traditional Illustrative / Fine Line Japanese / Irezumi Portrait Lettering / Script Other

Is this a cover-up?

Yes No

If cover-up, describe the existing tattoo (optional)

Describe your tattoo idea *

Reference images (optional)

Budget range *

Under $200 $200 – $500 $500 – $1,000 $1,000 – $2,500 $2,500+

Final pricing depends on size, detail, and session count — this just helps set expectations.

Preferred timeframe (optional)

Allergies / skin conditions / medical info (optional but recommended)

How did you hear about Harvey? (optional)

I confirm I am at least 18 years old and that the information provided above is accurate to the best of my knowledge. *

You'll get a confirmation on-screen once it's sent.