appointment request form
preferred name
*
first name
last name
pronouns
(she/her, he/his, they/them, etc.)
age
*
phone number
*
please enter a valid phone number and include area code
instagram @
*
N/A if none
e-mail
*
example@example.com (NA@NA.com if none)
birth date
*
-
Month
-
Day
Year
Date
Appointment
*
are you getting a new piercing, or are we downsizing an existing piercing?
Piercing
Downsize
Checkup
Other
what piercing(s) are you interested in?
*
if unknown, please type "unknown" and upload inspo photo. if it's a downsize, please type downsize. if we are doing a checkup, please type checkup.
do you want custom jewelry or basic jewelry?
*
custom jewelry is jewelry chosen by you that is available in our jewelry case. basic jewelry is included in the price of the piercing you choose. custom jewelry prices vary.
please upload photo if you dont know piercing name
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have you been pierced by me before?
*
yes
no
how did you hear about me?
please answer, it helps me know how my advertising is doing :)
I understand that:
*
I am 18 years or older, OR I have a notarized Florida State Minor Piercing Consent Form AND my LEGAL GUARDIAN is coming to my appointment
I agree that I MUST bring a government issued ID to my appointment
I agree that I will eat a meal before my appointment
I understand that my appointment might be canceled or rescheduled by Lea if needed
I understand that Lea needs to confirm my appointment, without her confirmation I do not have a set appointment
do you have a discount code?
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submit ✨
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