Ear Piercing Appointment Form

Ear Piercing Appointment Form

We are now offering ear piercing services! Schedule your appointment below.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Piercee's Date of Birth
Piercee's Age
Do you want both ears pierced by two piercers at the same time (mandatory for patients under 10, optional for those over 10)?
*Important Notice

Unfortunately, we cannot pierce anyone under the age of 6 at Norland Avenue Pharmacy. We apologize for the inconvenience.
Appointment Date and Time
Click here to download and print the consent form. Please fill out the consent form and bring it to your appointment. Contact the pharmacy at (717) 217-6790 with any questions.
Should be Empty:

*Important Notice