Name *

First Name

Last Name

Scheduling request is for *

Myself (age 18+)

Party of 2 (both 18+)

Minor child (age 15-17)

Minor child (age 12-14)

Minor child (age 8-11)

Party of 2 (one age 10-17)

Party of 2 (both age 10-17)

Phone *

(###)

###

####

I am aware fresh piercings shouldn't be submerged while swimming to prevent irritation or infection *

I am now!

Yup, not my first Rodeo!

Other Additional Services (if any)

check all that apply

x1 Additional Piercing (one side) (add 10 min)

x2 Additional Piercing (one side) (add 10 min)

x1 Additional Jewelry Change (add 5 min)

x2 Additional Jewelry Change (add 5 min)

x3-4 Additional Jewelry Change (add 5 min)

x1 Additional Downsize

x2 Additional Downsize

x3-4 Additional Downsize

Complimentary Consultation (add 10 min): Assess anatomy and Jewlery browsing

Detailed Curation (add 20 min): $10 Mapping things out visually, make jewelry choices and go over cost

Do you use breathing or hearing devices, headset/headphones, stethescope or other item that makes contact with the area to be pierced?

Yup

Nope

Would you like staff to wear a mask?

Yup

No Preferrence