| Date |
| Time |
| Appointment |
| TYPE OF PIERCING |
| Ear Piercing : details |
| Body Piercing : details |
| Facial/Oral Piercing : details |
| Nose > Extras |
| EXTRAS |
| 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 |
