Ear Piercing – One Ear

Please complete this form prior to making your purchase/appointment:

Ear/Nose Piercing Form

Name of Person Receiving the Piercing *

First

Last

Is this person over 18? *

• Yes
• No

If less than 18, choose age below (note we do not pierce younger than 3 months old):12-17 years old6-11 years old1-5 years old3 months - 11 months old

Name of Parent if child is under 18:

First

Last

Area to be pierced: *Ear - lobe(s)Ear - cartilageNose (outer nose only)

months Name ears

Do you prefer both ears to be pierced simultaneously? *

• Yes
• No

Submit

We use the Blomdahl piercing system, a medical grade system available only through healthcare professionals. Our earrings are not regular earrings. The earrings are specially designed for optimal healing. The piercings are housed in single use sterile cassettes, reducing the risk of infection and transmission of disease between patients. And all materials are made of medical grade plastics and titanium. This allows those with nickel and other contact allergies to comfortably wear earrings.  We can pierce anywhere on the outer ear, including cartilage.

**Pre-paid appointments may be refunded if cancelled 24 hours in advance.  If cancelled prior to appointment time but less than 24 hours in advance, appointment is non-refundable but may be re-scheduled.  There are no refunds for missed appointments.  A new appointment booking must be created.

Refunds and Returns Policy