Individual Request At Brass Rose

Individual Booking Request Form

( requests for 2 or more clients may be made by calling our toll free # 877-362-9009)

(Submitting this appointment form does not guarantee appointment availability)

(We will contact you, by phone, to confirm availability)

email: appointments@brassrose.com

Contact Information:

First Name:

Last Name :

Gender:

female male

E-mail address:

Phone Number:

Home:

Business:

Cell:

Street Address:

City:

State:

Zip:

Requested appointment dates:

1st .Choice: Day: Date:

2nd Choice: Day: Date:

Please indicate your requested services below:

Facials:
	Japanese Gemstone Facial
		Add Lip Wax		Add After Facial Makeup
		Add Eyebrow Wax		Add After Facial Blow Dry Style
	Microdermabrasion & Non-Surgical Facelift
		Add Lip Wax		Add After Facial Makeup
		Add Eyebrow Wax		Add After Facial Blow Dry Style
	Tibetan Renewal Facial
		Add Lip Wax		Add After Facial Makeup
		Add Eyebrow Wax		Add After Facial Blow Dry Style
	Glycolic Renewal Facial
		Add Lip Wax		Add After Facial Makeup
		Add Eyebrow Wax		Add After Facial Blow Dry Style
	Triple Action Facial
		Add Lip Wax		Add After Facial Makeup
		Add Eyebrow Wax		Add After Facial Blow Dry Style
	Tropical Renewal Facial
		Add Foot Massage		Add After Facial Makeup
		Add Lip Wax		Add After Facial Blow Dry Style
		Add Eyebrow Wax
	Romantic Rose Facial
		Add Lip Wax		Add After Facial Makeup
		Add Eyebrow Wax		Add After Facial Blow Dry Style

	Blemish Control Facial
		Add Lip Wax		Add After Facial Makeup
		Add Eyebrow Wax		Add After Facial Blow Dry Style
	Conditioning Facial
		Add Lifting Ingredients		Add After Facial Makeup
		Add Lip Wax		Add After Facial Blow Dry Style
		Add Eyebrow Wax
	Baseline For Men Facial
		Add Lifting Ingredients		Add Eyebrow Wax
		Add Lip Wax
	Back Facial

Massages
	Ayurveda Face and Body Massage		Raindrop Therapy Massage
		Add Reflexology		--
	Stone Therapy Massage		Lomi Lomi Massage
		Add Reflexology		Add Reflexology
	Thai Hot Poultice Massage		Golden Swan Massage
		Add Reflexology		Add 15 minute extension
	Soft and Soothing Massage			Add Reflexology
		Add 15 minute extension	Rejuvenating Massage
		Add Reflexology		Add 15 minute extension
	Sports Massage			Add Reflexology

	Pregnancy Massage		Mini Retreat

	Reflexology Only

Luxurious Retreats ( Body Treatments PLUS Massage)
	Ayurveda Mind & Body		Scentual Garden
		Add Reflexology		Add Reflexology
	Hawaiian Healing Ritual		Tea and Roses Elegance
		Add Reflexology		Add 15 minute extension
				Add Reflexology
	Stone Body Balancer		Ayurveda Purva Karma
		Add Reflexology		Add 15 minute extension
				Add Reflexology

Hand Treatments
	Reconstruction		Lavender Luxury
		Add French Polish		Add French Polish
		Add Nail Striping		Add Nail Striping
		Add Nail Graphics		Add Nail Graphics
	Hawaiian Hands		Milk and Honey
		Add French Polish		Add French Polish
		Add Nail Striping		Add Nail Striping
		Add Nail Graphics		Add Nail Graphics
	Polish Change Only

Foot Treatments
	Stone and Lava Mud		Reconstruction
		Add French Polish		Add French Polish
		Add Nail Striping		Add Nail Striping
		Add Nail Graphics		Add Nail Graphics
		15 Minute Massage Extension		15 Minute Massage Extension
	Aloha Smoothie		Coconut Cream
		Add French Polish		Add French Polish
		Add Nail Striping		Add Nail Striping
		Add Nail Graphics		Add Nail Graphics
		15 Minute Massage Extension		15 Minute Massage Extension
	Milk and Honey		Polish Change Only
		Add French Polish
		Add Nail Striping
		Add Nail Graphics
		15 Minute Massage Extension

Spa Lunch
		Chef Salad	Chicken Caesar Salad
		Chicken Mandarin Salad	Vegetarian Salad
				Egg OK Cheese OK Tuna OK

After Spa Hair Blow Dry Style
		Add Hair Ironing

Makeup
		Practice Makeup for Special Occasion or Bride		Special Occasion or Bridal Makeup
		Makeover with Instruction

Hair Styling
	Regular Hair Styling
		Shampoo and Blow Dry
		Wash and Set
		After Spa Blow Dry Style
	Formal Hair Styling
		Practice Formal Style or Upsweep		Formal Style or Upsweep
		Practice Bridal Style		Bridal Style
	Hair Cuts
		Cut and Blow Dry Style		Gentleman's Cut
		Trim Beard/Sideburns
	Hair Color and Highlighting
		Single Process Color		Cap and Weave Highlighting
		Partial Foil or Low Lights		Full Foil
	Hair Straightening and Perms
		Chi Straightening		Perm
		Spiral Perm
Hair Styling Add Ons
		Add Hair Ironing to Any Styling		Add Conditioning to any service
	Hair Repair and Conditioning Treatments
		Deep Heat Fusion w/ Blow Dry Style		Conditioning Treatment Only with Blow Dry Style

Waxing
	Facial		Body
		Full Face		Back
		Eyebrows		Chest
		Lip		Abdomen
		Cheeks		Shoulders
		Chin		Neck
	Arms/Hands		Legs/Feet
		Full Arm		Full Leg
		Half Arm		Half Leg
		Underarm		Feet
		Hands		Toes
		Fingers
	Bikini
		Bikini Only		Bikini Plus Half Leg
		Bikini Plus Full Leg		Brazillian

Comments:

Type in any special instructions