@Philip Preece Erland Sommarskog
You can check frequently asked questions for SQL Server on Azure VMs -
https://learn.microsoft.com/en-us/azure/azure-sql/virtual-machines/windows/frequently-asked-questions-faq?view=azuresql#administration
Can I install a second instance of SQL Server on the same VM? Can I change installed features of the default instance?
Yes. The SQL Server installation media is located in a folder on the C drive. Run Setup.exe from that location to add new SQL Server instances or to change other installed features of SQL Server on the machine. Some features, such as Automated Backup, Automated Patching, and Azure Key Vault Integration, only operate against the default instance, or a named instance that was configured properly (See Question 3). Customers using Software Assurance through the Azure Hybrid Benefit or the pay-as-you-go licensing model can install multiple instances of SQL Server on the virtual machine without incurring extra licensing costs. Additional SQL Server instances can strain system resources unless configured correctly.
What is the maximum number of instances on a VM?
SQL Server 2012 to SQL Server 2019 can support 50 instances on a stand-alone server. This is the same limit regardless of in Azure on-premises. See best practices to learn how to better prepare your environment.