TO REQUEST AN APPOINTMENT PLEASE COMPLETE THE FORM BELOW.
COMPLETION OF THIS FORM DOES NOT GUARANTEE AN APPOINTMENT.

YOU WILL RECEIVE AN EMAIL RESPONSE SHORTLY WITH FURTHER INSTRUCTIONS

**Must be 13 ACCOMPANIED by a PARENT or you must be 16 with valid photo I.D. for basic piercings.
Genital piercing and Microdermal piercing 18+ ONLY – YOU WILL BE ASKED FOR I.D. upon arrival

IF YOU ARE LOOKING TO GET PIERCED WITH A FRIEND, THEY MUST ALSO FILL OUT THEIR OWN FORM. EACH CLIENT LOOKING TO REQUEST A PIERCING MUST COMPLETE A FORM. ONLY SUBMIT THIS FOR WITH INFORMATION RELATING TO YOURSELF!

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