Pre-appointment form

I believe inclusivity is important in all aspects of life and piercing should be no exception. To ensure an even smoother and more personalized experience, I now offer you the chance to let me get to know a bit more about you before your appointment. This also enables me to offer more specific piercing advice and recommendations depending on your lifestyles and health condition (if you have any). You can enlist a trusted friend or family member to help you fill out this form.

Additionally, you’re more than welcome to contact me with any additional questions or information you feel may be relevant.

All completed forms are securely double-password and anti-virus protected as standard.

This form is optional and does not replace the consent form filled out at the beginning of each appointment. All questions except for those marked ‘(required)’ are optional.

About you

← Back

Thank you for your response. ✨

Pronoun(s) & Title

Full legal name(s) (as seen on Government issued I.D.)

What name would you like me to call you?

What’s your date of birth? DD/MM/YYYY

Please select the option that applies to you.

Do you require extra assistance with your appointment due to a health condition?
E.g. a chaperone, guide dog assistance, quiet appointment, room on ground level, etc.

Do you have a job that could affect healing or longevity of a piercing?
E.g. Manual labour, regularly exposed to adverse weather/conditions, wet and damp environments, anything that requires use of head gear/headsets, etc.

Do you have any regular hobbies that could affect healing or longevity of a piercing?E.g. Swimming, contact sports/exercise, etc.

Do you plan to/already have any regular cosmetic procedures done that may affect healing or longevity of a piercing?
E.g. Dermal fillers, spray/fake tan, botox (a.k.a anti wrinkle), facials, lasering, etc.

Do you have any phobias?
E.g. Needles, sight of blood, etc.

Do you have a history of fainting?

Do you have any allergies?

Do you have any other health conditions?

Are you/do you plan to be pregnant and/or breastfeeding?

Is there anything else you would like to discuss before or during your appointment?

Do you have an e-mail address?

Your phone number?

I confirm that all information provided in this form is factual and accurate to the best of my knowledge.

Pre-appointment form

Thank you for your response. ✨

Share this: