Piercing Consultation Request
Share your details, piercing preferences, and photo inspiration to help us assess suitability and book your consultation.
About You
Full Name
*
First Name
Middle Name
Last Name
Preferred Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Age
*
Parent/Guardian Details (if under 18)
Your Piercing
Which piercing are you interested in?
*
Please Select
Ear lobe
Helix
Tragus
Conch
Daith
Rook
Industrial
Nostril
Septum
Lip
Eyebrow
Navel
Nipple
Other (please write below)
Other piercing:
Which side?
*
Left
Right
Both
Not sure
Is this your first piercing?
*
Yes
No
Have you had this piercing before?
*
Yes
No
If yes, when was it removed or fully healed?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What jewellery style are you interested in?
Preferred metal
*
Please Select
Titanium
Gold
Surgical steel
Niobium
Silver
Other
Inspiration
Reference Photos
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Photo of Piercing Area
Upload a File
Drag and drop files here
Choose a file
Cancel
of
What are you hoping to achieve?
Consultation & Suitability
Previous piercing or healing problems
Allergies or sensitivities to jewellery or materials
Anatomy or previous piercing notes
Anything you're unsure or nervous about
Appointment
Preferred days for appointment
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How soon would you like the piercing appointment?
Please Select
As soon as possible
Within 1 week
Within 2 weeks
Within 1 month
Flexible timing
Other
Are you flexible with appointment times?
*
Yes
No
Final bit
How did you hear about us?
Please Select
Instagram
Facebook
TikTok
Google Search
Walk-in
Friend/Family
Website
Other
Any questions before the consultation?
I understand that submitting this form does not confirm an appointment.
*
I understand
I understand that my piercing will only be carried out if the piercer considers the placement suitable and safe.
*
I understand
Submit
Should be Empty: