Name *

First Name

Last Name

Phone *

(###)

###

####

Scheduling request is for: *

select all that apply

Myself (age 18+)

Minor child (age 16-17)

Minor Child (age 12-16)

Minor Child (age 8-11)

Party of 2

Myself (age 14-17)

Desired Service (select all that apply)

x1 Fresh Piercing

x2 Fresh Piercing

x3 Fresh Piercing

x4 Fresh Piercing

x5 Fresh Piercing

x6 Fresh Piercing

x1 Jewerly Change

x2 Jewerly Change

x3 Jewerly Change

x4 Jewerly Change

x5 Jewerly Change

x1 Downsize Existing Piercing (post only)

x2 Downsize Existing Piercing (post only)

x3 Downsize Existing Piercing (post only)

x4 Downsize Existing Piercing (post only)

Complimentary Consultation

Detailed 30min Curation

Full Curation with additional services

Troubleshoot a piercing done with us

Troubleshoot a piercing done elsewhere

x1 Jewelry removal

x2 Jewelry removal

x3 Jewelry removal

x4 Jewelry removal

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

Yup

Nope