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Your Details
Name
(Required)
First
Last
Pronoun
– Select –
She/her
He/him
They/them
Ze/hir
Xe/xem
Ver/vir
Te/tem
E/em
Other
Other Pronoun
Email
(Required)
Email
Confirm Email
Your Piercing
Piercing Area
(Required)
Select
Children Lobes (Aged 4-8)
Children Lobes (Aged 8-16)
Adult Ear Lobes
Large Gauge Lobes
Helix (Ear rim)
Inner Conch
Daith
Tragus
Snonch
Forward Helix
Rook
Flat (Outer Conch)
Other Ear
Nostril
High Nostril
Septum
Bridge
Eyebrow
Other Facial
Philtrum (Centered upper lip)
Monroe (Side upper lip)
Labret (Centered lower lip)
Side Lower Lip
Tongue
Vermilion Lip (Ashley)
Vertical Lip
Tongue Web
Smiley
Dahlia
Cheek
Navel Anchor
Facial Anchor
Torso Anchor
Forehead Anchor
Neck Anchor
Surface Bar
Intimate Surface
Industrial
Custom Industrial
Navel
Breast Nipple
Chest Nipple
Inverted Nipple
Transponder Piercing
Prince Albert (PA)
Scrotal
Guiche
Frenum
Ampallang
Apadravya
Reverse PA (RPA)
Foreskin
Other Penile
Vertical Clitoral Hood (VCH)
Labia Minora
Horizontal Clitoral Hood (HCH)
Triangle
Christina
Labia Majora
Other Vulva
Approximate Date of Piercing
(Required)
The last week
The last month
2-3 Months
4-6 Months
6-9 Months
1-2 Years
Over 2 years
Unknown!
Other piecing area
(Required)
Piercing Studio
(Required)
Pierced at Stone Heart
Pierced elsewhere
How can we help
(Required)
General check-up
Downsize check-up
Am I ready to change my jewellery?
I’m having a problem! HELP!
This field is hidden when viewing the form
Weeks since piercing
Who pierced you
(Required)
No clue!
joeltron
Fabio
Sarah
How was your piercing done?
(Required)
Piercing gun
Piercing needle
Other
Have you contacted the store that did your piercing?
(Required)
Have you been in contact with the person who pierced you about your complications? What advice did they give you?
Troubleshooting
Aftercare you are currently using
(Required)
Rinsing in the shower
Sterile saline spray (eg: Neilmed)
Non-sterile saline solution
Contact Lens Solution
Ear Piercing Care Solution (Pump)
Other (Please specify)
Other aftrercare you are using
(Required)
Other aftrercare you are using
Medical Conditions
(Required)
None that would affect the piercing
Previous low iron/anemia
Current low iron/anemia
Other (Please specify)
Other Medical Conditions
(Required)
How many times a day are you cleaning it (approximately)
(Required)
Not cleaning anymore
1x daily
2x daily
3x daily
4+ daily
Do you use headphones/earbuds?
(Required)
YES (Earbuds)
YES (Over ear Headphones)
YES (Loops/ear protection)
NO
When do you generally Shower/Bath?
(Required)
Mornings
Afternoons
Evenings
Both Mornings & Evenings
Do you spin or rotate your jewelry?
(Required)
YES (a little)
YES (a lot)
NO
Drying before bed
(Required)
I have not been
Drying with towel/tissue/paper towel
No-touch drying
Other (Please specify)
Drying before bed
(Required)
Do you pick at your crusties?
(Required)
YES (fingers)
YES (q-tips/tweezers)
NO
(don’t lie!)
Do you have pets or stay with a friend that does?
(Required)
YES
NO
Have you been sick lately?
(Required)
NO
YES (Please specify)
What were you sick with and how long for?
(Required)
Are you sleeping on the area at all?
(Required)
Sometimes
Yes
Not at all
Have you been swimming recently?
(Required)
YES (Chlorine pool)
YES (Salt pool)
YES (Ocean)
NO
Are you playing with or touching the piercing?
(Required)
Sometimes
Yes
Not at all
Your jewellery
Piercing Jewellery
(Required)
I’ve still got my original jewellery installed
I have changed my jewellery
I no longer have jewellery installed
How long has it been out?
(Required)
Today
This last week
This last month
Other
Who changed it?
(Required)
At our studio
Another store
Another piercing studio
Friend / family member
Myself
Other
What jewellery type do you have in?
(Required)
Unknown
External thread
Butterfly Clip (“normal” studs)
Cork screw (nostril pig tail)
Internally threaded
Threadless
Other
Where is the jewellery from?
(Required)
At our studio
At another studio
Online / another store
Other
When was it changed?
(Required)
Today
This last week
This last month
Other
Photos
Pictures of the piercing [NO TOUCHING]
(Required)
Remember to NOT touch the area at all when taking photos and supply both front and back photos (if applicable).
How can we help?
(Required)
Consent
(Required)
I understand that the piercing staff are not doctors or medical professionals.
Their advice should be used as a guideline and is not intended to substitute for the advice of a doctor or medical professional.