CARL'S - Ear Piercing Appointment Form

Ear Piercing Appointment Form

We are now offering ear piercing services! Schedule your appointment below.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Piercee's Date of Birth *
Piercee's Age*
Unfortunately, we cannot pierce anyone under the age of 6 at Norland Avenue Pharmacy. We apologize for the inconvenience.
Do you want both ears pierced by two piercers at the same time (mandatory for patients under ten, optional for those over ten)?*

YesNo
Appointment*
*Important Notice
Click here to download and print the consent form. Please fill out the consent form and bring it to your appointment. Contact the pharmacy at (717) 597-2426 with any questions.
Should be Empty:

Ear Piercing Appointment Form