Nipple Tattoo Bookings

No tattoo bookings can be made without a completed application being submitted, including reconstruction photos. This request is obviously at your discretion, however we are not in a position to offer our free service without an assessment of your medical history, reconstructed breasts and associated scar tissue.

The provided images must be current, clearly viewable and taken from the front, left side and right side of the breast/s. Please ensure no faces are captured in the images.

Once your medical history and images have been reviewed, you will be contacted via email and booked at the next available appointment,
near your locality, or placed on our waiting lists.

*The Survivors Ink website is a secure Australian network and meets Australian legislation requirements.

*Please allow 7-14 days for our volunteers to respond to your booking request.

All online booking requests are treated as (Medical - In - Confidence)

* Name
* Email
* Mobile
* Location
* State
* How did you find us?

Medical History

* Diagnosis Date
* Current Medications:
* Age
* Sex

Surgery / Reconstruction Dates

* Mastectomy Date
* Breast Reconstruction
* Nipple Reconstruction
* Chemo Therapy
* Radiation Therapy
* Known Complications

Breast Reconstruction Photos (Medical - In - Confidence)

* Front
* Right
* Left
Additional comments: