APPOINTMENT REQUEST FORM
Piercing
Personal information
Please fill in the boxes below.
Name (as shown on photographic ID)
*
First Name
Last Name
Preferred name
Any chosen for yourself or nickname.
Preferred pronouns
e.g. she/her, he/him, they/them
Date of birth
*
-
Month
-
Day
Year
Email address
*
example@example.com
Contact number
*
Please enter a valid phone number.
Instagram handle
e.g. @pyxiepiercings
I am happy to be contacted via Instagram and will check my message requests if necessary.
Yes
No
The whats, wheres and whens
Tell me more!
Which piercing(s) would you like to have done?
*
Please note that I am only able to do up to three piercings per person per day, depending on what and where, with the exception of four ear lobe piercings. If you would like more than the limit, please enter all and we can discuss multiple appointments.
When are you available? (Select all that apply.)
*
Tuesdays (until 21st May 2024)
Wednesdays (from 5th June 2024)
Thursdays
Fridays
Saturdays
When would you like to get pierced?
*
As soon as possible
I have a specific date in mind
If you have a date in mind, please pick below.
-
Month
-
Day
Year
I am able to make some exceptions outside of the above weekdays but I can’t make any promises.
Extra information
Remember: it’s all confidential.
Do you have any medical conditions that may affect either the piercing process itself or healing of the piercing?
*
If you’re unsure, pop it in anyway.
Do you have any extra requirements to make your experience more suited to you?
*
This can include a quiet room, assistance of a carer, a longer appointment for learning/behavioural difficulties, sensory aid and more. Say the word!
I acknowledge that I will be required to pay a non-refundable deposit to secure any appointment made; the amount is subject to factors such as service charge and jewellery fee, and will be determined by Bell. Any amount paid upfront will be deducted from the total cost.
*
I agree
Cancellations or rescheduling must be made at least 48 hours before your appointment, or you risk losing your deposit. Some emergencies may apply and I will contact Bell as soon as I know of any changes that need to be made.
*
I agree
I understand that this form does not automatically guarantee an appointment, and that I will be contacted by Bell within 2-3 days of submission. I confirm that I am 18 years old or over, and can provide photographic ID (passport or drivers/provisional license) on the day of my appointment.
*
I agree
Submit
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