Date |
Time |
Appointment |
TYPE OF PIERCING |
Ear Piercing : details |
Body Piercing : details |
Facial/Oral Piercing : details |
Nose > Extras |
EXTRAS |
Add Other Services |
Other Services > Description |
Other Services > Price |
Description |
ARTIST |
Total |
Are you 18 or older ? |
Age |
Name |
Surname |
Date of birth |
ID number |
Email |
Phone |
Address |
Parent's Name |
Parent's Surname |
Parent's Date of birth |
Parent's ID number |
Parent's Email |
Parent's Phone |
Parent's Address |
Permission |
Parent signature |
Any heart condition: |
Allergies to: anesthetics, adhesive plaster, jewellery or latex? |
Are you pregnant or breastfeeding? |
Are you taking any blood or medication as Warfarin, Aspirin etc? |
Please list any current medications/treatments from the hospital |
How did you hear about us? |
How did you hear about us? :: other |
Customer signature |
GDPR Agreement |
work_done |
send aftercare email |
|
Total |