Piercing Appointment Form

Piercing Appointment
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
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Are you over 18 years of age?

YesNo
If no, due to the law of the State of New York, if a person is under the age of 18, they must fill out a Parental/Legal Guardian Consent Form.
Click Here for Parental Consent Form

NOTICE: FORM MUST BE NOTARIZED AND PARENT/LEGAL GUARDIAN MUST COME WITH THE MINOR TO THE APPOINTMENT.
Please specify which type of piercing you want below.
EAR PIERCING
FACE PIERCING
BODY PIERCING
Jewelry Changes: $25 Jewelry Removal $10
Please select when you want your piercing below.
Should be Empty: