ENTRY TYPE
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
VALUES
04/13/2024
12:25:22 PM
04/13/2024 11:30
FACIAL / ORAL
Nose - £ 30.00
Gem - £ 5.00
None - £ 0.00
Right nostril
Giuseppe
£ 35.00
Yes
37
Ciara
Hanley
12/05/1986
Ph0800837
ciara_hanley@hotmail.com
+447804766555
21 monro way London E5 8ny GB
No
No
No
Google search
I consent to having this website store my submitted information so they can respond to my inquiry.
FALSE
No
£ 35.00