Piercing Request Form

Piercing Request Form

THIS FORM IS FOR ONE PERSON. If you are wanting to book an appointment for multiple people please have each person fill out their own form. *PLEASE NOTE IF THIS IS FOR CHANGING OR REMOVING JEWELRY PLEASE FILL OUT OUR OTHER FORM. IF THIS IS TO JUST PURCHASE JEWELRY PLEASE EMAIL MIKE AT MIKE.PIERCINGS@YAHOO.COM
Name of person being pierced*

First NameLast Name
Name on card being used for deposit*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
Age of Client being pierced*
Please select a drop down for 1-2 or 3-4 Piercings

1-2 Piercings
1-2 Piercings half hour slot

Please use the drop down menu to select which piercings you are wanting.
Piercing #1
Piercing #2

3-4 Piercings
3-4 Piercings hour slot

Please use the drop down menu to select which piercings you are wanting.
Piercing #1
Piercing #2
Piercing #3
Piercing #4

All piercing prices include jewelry if you have sensitive skin we may suggest an upgrade in jewelry for $15
If you have any information you would like to add or questions. For example if you have sensitive skin or any skin conditions please note it below.
Terms and Conditions- FAILURE TO FOLLOW WILL RESULT IN LOSS OF DEPOSIT

A 24 hour notice is required to reschedule your appointment and keep your deposit. Failure to keep your appointment or failure to show up on time (within ten minutes of the appointment time) will result in a forfeiture of this deposit. Client must provide photo ID. If appointment is for a minor the parent must have ID. At this time ONLY THE CLIENT and ONE GUEST can come into the shop unless the person getting a piercing is a minor, then ONLY the minor and ONE PARENT (MUST BE A PARENT NOT OTHER FAMILY MEMBER) will be allowed in. If a LEGAL GUARDIAN is coming in with a minor that is NOT the parent they will need GUARDIANSHIP PAPERWORK FROM A JUDGE. Children under the age of 8 are not permitted in the building. FAILURE TO COMPLY WITH THE ABOVE, FAILURE TO ARRIVE ON TIME, FAILURE TO BRING AN ACCEPTED VALID ID (GOVERNMENT ID OR PASSPORT NOT EXPIRED) OR FAILURE TO RESCHEDULE WITHIN 24 HOURS OF YOUR APPT. TIME WILL RESULT IN FORFEITURE OF DEPOSIT.
YOU WILL SCHEDULE YOURSELF AFTER HITTING SUBMIT.

Click on the book an appointment button on the page you’re taken to and pick out you’re time.
Should be Empty:

Terms and Conditions- FAILURE TO FOLLOW WILL RESULT IN LOSS OF DEPOSIT