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Please fill out this form with as much information as possible to ensure a smooth consultation process. We will provide a response with in 24 hours.
12
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1
Name
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First Name
Last Name
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2
Are you at least 18 years old?
*
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Yes
No
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3
Email
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example@example.com - Please check your SPAM folder if you do not receive a response within 48 hours.
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4
Phone Number
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5
How did you hear about us?
Google
Instagram
Friend/Family
In the area
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6
How would you like us to contact you?
Phone call
E-mail
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7
Would you prefer?
In-person Consultation
Consultation Via email
Same day Walk-in
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8
Desired appointment date for your Piercing or consultation?
*
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Date
Month
Day
Year
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9
What were you looking to have pierced?
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10
What jewelry type are you looking for?
Titanium
Gold Finish
Rose Gold Finish
White Gold Finish
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11
Your price budget
*
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$100 -$150
$150 - $200
$250 - $300
$300+
$100 -$150
$150 - $200
$250 - $300
$300+
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12
Please upload piercing reference photos here.
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