Booking form

APPOINTMENT REQUEST FORM

Piercing
Personal information

Please fill in the boxes below.
Name (as shown on photographic ID)

First NameLast Name
Preferred name
Any chosen for yourself or nickname.
Preferred pronouns
e.g. she/her, he/him, they/them
Date of birth

MonthDayYear
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. (If yes, please make sure you’re following me @pyxiepiercings as some profile settings restrict me from contacting you if you’re not!)
The whats, wheres and whens

Tell me more!
Which service(s) would you like to book?
Please provide any further information on the service(s) you’d like.
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.
If you have a vision for your piercing, including placement or jewellery choice, please upload any relevant images.

Cancelof
When are you available? (Select all that apply.)
When would you like to get pierced?
If you have a date in mind, please pick below.

MonthDayYear
Please note that I don’t work Wednesdays or Sundays!
Extra information

Remember: it’s all confidential.
Are you taking any medication? If yes, please specify.
All are relevant.
Do you have any medical conditions?
Some can pose health risks or affect healing, so I will need to know prior to your appointment.
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.
Cancellations or rescheduling must be made at least 24 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 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 the person wanting the piercing(s) is 16 years old or over, and can provide photographic ID (passport or drivers/provisional license) on the day of my appointment.
Should be Empty:

APPOINTMENT REQUEST FORM

Personal information

The whats, wheres and whens

Extra information