Client Healing Concern (HC Form)

Today's Date *

Submitter Name *

Submitter Email *

Submitter Phone *

Technician Name

Tatt2Away Center Business Name

Tatt2Away Center Address

Tatt2Away Center City *

Tatt2Away Center State or Province *

Tatt2Away Center Region (if applicable)

Tatt2Away Center Country

Client and Tattoo Description

Client Age *

Client Gender *

Client Genetic Ethnicity

Tattoo Location *

Tattoo Description *

Estimate date Tattoo Was Finished On *

Your Name *

Your Residence Address

Your Residence City *

Your Residence State or Province *

Residence Country

Client Email *

Client Phone *

Instigating Treatment and Healing Concerns

Which TEPR treatment session in the planned series instigated the healing concern?

Instigating Session in Series *

Prior Treatment Date {where applicable) *

Instigating Treatment Date *

Healing Concern Date *

Healing Concern Description *

Photographic Record

All Available photographs MUST be submitted. Photographs submitted by technicians are expected to be high quality: high resolution, in focus, and uniformly light. Immediate PRE- and POST-treatment photographs taken during EACH treatment session are part of every TEPR protocol. At a minimum, these photographs will be available and must be submitted.

Instructions for submitting photographs and data forms.

Please change the file names from the earliest "01" to the latest to keep them in sequence before uploading.

Treatment and Healing Photos *

Choose File

Jazz was sensational! She is excellent at her craft, and it's comforting to know she has a nursing background. She numbed my arm very well so I didn't feel much pain at all! Jazz also has cool taste I'm music, her office has a chill vibe and she was able to get the job done effectively while having lighthearted conversation the entire time. Tattoo removals don't sound like a fun experience, but if Jazz is doing the job, I know I can look forward to my next treatment. Jazz rocks!

Ethan Schaecher

10/12/2022

Jazz is very professional and she makes sure you understand how everything works. My tattoo has left a lot of scar tissue and was also very deep. A lot of my tattoo has been removed and my scar tissue is also not as bad it was which is very surprising. It’s definitely flattened it out a lot. I’m very happy with the results I’m getting. So thank you jazz.

Joshua Stratton

22/11/2022

Jazz is very professional and educates you about every aspect of the process!

Angie Quinlan

17/11/2022

Jazz was knowledgeable and great. Couldn't ask for a better treatment.

Eric Parry

21/10/2022

Jazz is great. She took the time to put me at ease and is very personable. I highly recommend her.

Eric Holman

07/10/2022

On my 4th treatment. The sessions are making my tattoo dissappear. I voukdnt be happier with how it's going. Jazz is my technician and she makes every meeting aersome. Definitely continuing till it's gone!

Justin Mick

30/09/2022

Had tattoo removal performed by Jazz. Worked out great and is really helping to get my unwanted tattoo gone over time. Jazz is great and really helped me through the process and the aftercare. Gave great instructions and is very caring and concerned about my welfare. Would recommend to someone looking to remove an unwanted tattoo.

Yvonne Mayberry

27/09/2022

Easy to work with, great experience!

Sara Greenwell

26/09/2022

Awesome experience. Had my first treatment today and can't wait for my next! Jazz is very friendly and awesome. Definitely looking forward to my next session!

justin mick

07/04/2022