ENTRY TYPE
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
VALUES
03/27/2023
06:29:05 PM
03/27/2023 17:30
EAR PIERCING
Lobe - £ 15.00
Giuseppe
£ 15.00
Yes
29
Rafadl
Sousa
06/16/1993
687654390
pavarottistudio@gmail.com
+447654338765
11 Sylvester Path London E81EN GB
No
No
No
Walking by the studio
I consent to having this website store my submitted information so they can respond to my inquiry.
FALSE
No
£ 15.00