Piercing Request Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How would you like to be contacted?
*
Text
Email
Are you 18 or older?
*
Yes
No
Do you have any health issues?
*
Yes
No
If yes, please explain
My Products
*
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( X )
Anti - Tragus
Minimum Age Requirement 15 +
$
60.00
How Many
One
Two
Basic Tongue ONLY
Minimum Age Requirement 18 +
$
60.00
Belly
Minimum Age Requirement 13 +
$
60.00
How Many
One
Two
Conch
Minimum Age Requirement 13 +
$
60.00
How Many
One
Two
Daith
Minimum Age Requirement 13 +
$
60.00
How Many
One
Two
Dermal Anchors
Minimum Age Requirement 18 +
$
75.00
How Many
One
Two
Dimples
Minimum Age Requirement 18 +
$
115.00
Earlobe
Minimum Age Requirement 3 months +
$
60.00
How Many
One Ear
Two Ears
Eyebrow
Minimum Age Requirement 15 +
$
60.00
How Many
One
Two
Forward Helix
Minimum Age Requirement 13 +
$
60.00
How Many
One
Two
Helix
Minimum Age Requirement 13 +
$
60.00
How Many
One
Two
Industrial
Minimum Age Requirement 13 +
$
70.00
How Many
One
Two
Labret
Minimum Age Requirement 15 +
$
60.00
How Many
One
Two
Lip
Minimum Age Requirement 15 +
$
60.00
Which Piercing
Basic Iip
Angel Bites
Cyber Bites
Dahila
Dolphine Bites
Horizontal Lip
Inverse Lip
Joker Bites
Snake Bites
Spider Bites
Madonna
Medusa
Monroe
Viper Bites
Jestrum
Nipple
Minimum Age Requirement 18 +
$
60.00
How Many
One
Two
Nose
Minimum Age Requirement 13 +
$
50.00
Rook
Minimum Age Requirement 13 +
$
60.00
How Many
One
Two
Septum
Minimum Age Requirement 13 +
$
60.00
Smiley
Minimum Age Requirement 16 +
$
65.00
Snug
Minimum Age Requirement 13 +
$
60.00
How Many
One
Two
Tragus
Minimum Age Requirement 13 +
$
60.00
How Many
One
Two
Triple Forward Helix
Minimum Age Requirement 13 +
$
135.00
How Many
One
Two
If you didn't find the piercing you're looking for on the list above PLEASE contact us for further information.
(726) 234- 3079
Notes & questions you want to add
Appointment
*
I agree with the following statements:
*
You must call to cancel your appointment (726) 234-3079.
Prices above include the piercing and standard piercing jewelry. It does NOT cover any aftercare. Aftercare is $10 - $16 (plus tax) and purchased seperatly at the time of service.
Appointments for piercings are required.
I will provide a valid government issued photo ID. (ALL minors will need additional documents please call for more information)
I understand failure to arrive on time or failure to bring a valid ID will result in forfeiture of deposit.
No call No Show appointments will automatically forfeit deposit.
I understand that this booking request form does not guarantee me an appointment.
I understand that I will be contacted for follow up and will be required to send a deposit via etransfer.
I acknowledge that until the deposit has been received my appointment has not been confirmed.
I understand that this is a non refundable deposit.
I understand that if I make changes to my piercing after submitting this request and booking the appointment the cost may vary from the quote I was given.
I have read and agree to the above statements.
Submit
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