Body Piercing Request Form

Body Piercing Request Form

This form is for requesting an appointment for a body piercing service, whether new or existing. If you are unsure of an answer, please answer with your best guess, and indicate in the comments at the bottom how we can help.
Client Information
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com **Please check your spam folder if you do not get a response within 24 hours. If you use iCloud email, MAKE SURE YOUR INBOX IS NOT FULL or our response will not go through to you.**
Have you been pierced at Body Designs before?*

YesNo
If you have been pierced at Body Designs before, who was your body piercer?
Is this inquiry for a minor (under 18 years old)?*

YesNo
If this inquiry is for a minor, what is their name AND age?
Piercing Information
Type of Inquiry*

New piercingJewelry changeExisting piercing issueJewelry/aftercare purchase
Area(s) of body to be pierced/addressed:*
Example: left ear rook, nostril, ear lobes, etc
Body Piercer:*
Scheduling

This is not guaranteeing an appointment, but is intended to streamline the process when it comes to scheduling your appointment.
Preferred Days of the Week*

WednesdayThursdayFridaySaturdaySundayNo Preference
Preferred Time of Day*

3:30pm4:00pm4:30pm5:00pm5:30pm6:00pm (not available on Sundays)No Preference
Inquiries & Additional Comments*
Should be Empty:

Client Information