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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.

Once your medical history and images have been reviewed, you will be booked at the next available appointment,
near your locality.

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




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: