Medical Ear Piercing Request

Medical Ear Piercing Request

for Roswell Alpharetta Atlanta at 1305 Hembree Road, STE 203, Roswell GA 30076
What you get:

Medical Ear Piercing by Physician - Limited slots available.

EXTRAS:

PLUS THESE EXTRAS

Free, no questions re-piercing for 12 months ($480 value)
Two free pairs of Titanium and Gold studs 5mm ($90 retail price)
Optional numbing cream ($130 value)(must arrive 1 hour before appointment time) if requested
Total value $975

What you pay: ONLY $240

Get your ears pierced by a pediatrician and medical professional with hypoallergenic earrings and a sterile procedure.

We have limited slots available.

Some families have to travel very far to come here but we will continue to do our best to serve you. That is why we insist on pre-booking for your appointment.

NO PHOTOS OR VIDEOS ALLOWED

Please do not abuse the privilege and be courteous to the staff as they continue to work professionally

Please make sure you watch the video that is sent at the end of this booking.
Name of Person Booking*

First NameLast Name
Email*
example@example.com
Name of Person Who's Ears Are To Be Pierced*

First NameLast Name
What is the age of the person who needs to have their ear pierced? *
Mobile Phone Number*
Please enter a valid phone number.
This is a medical facility with restrictions on video and photo taking. I understand that this will be done in a medical clinic and video recordings are not allowed neither are photographs during the procedure.*

I understand and accept
Has this person received the tetanus vaccine (DTaP, TDaP or Td) within the last 10 years? Without this, the procedure will not be performed as this is a requirement.*

Yes
I agree to pay the ear piercing fee (FOR PIERCING BOTH EAR LOBES ONLY) and by checking the boxes below I agree that this is -*

NON REFUNDABLE FEENOT ABLE TO BE RESCHEDULED - be certain of your date before bookingNOT TRANSFERRED OR REPORTED TO INSURANCE
I agree that: 1. You will choose the spot for perforation. 2. Approve the spot marked for perforation by the provider. 3. Accept the outcome based on your chosen location for perforation.-*

I will choose the spot for piercingApprove the spot marked for piercing by the providerAccept the location and outcome of the piercing based on my choice
Appointment
Payment Terms: ALL PAYMENTS ARE FINAL. NO REFUNDS FOR MISSED APPOINTMENTS AND NO RESCHEDULING IS POSSIBLE. IF YOU MISS AN APPOINTMENT OR ARE LATE, YOU WILL HAVE TO PAY FOR A NEW APPOINTMENT. You will now be redirected to the payment portal on stripe.*
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Medical Ear Piercing + 1 year free re-piercingMedical Ear Piercing by Physician - Limited slots available PLUS THESE EXTRAS Free, no questions re-piercing for 12 months ($480 value) Two free pairs of Titanium and Gold studs 5mm ($90 retail price) Optional numbing cream ($130 value)(must arrive 1 hour before appointment time) if requested Total value $975
$240.00
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