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23
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1
Name
First Name
Last Name
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2
Number
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3
Email
example@example.com
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4
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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5
How did you find me?
Friend, Facebook, Instagram, TikTok other? If other please list.
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6
Have you ever worn extensions before?
Clip in, tape in, beaded wefts, micros, great lengths, halo, toppers wigs, etc. If so please list. . .
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7
Do you currently have extensions installed?
YES
NO
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8
Which best describes your hair strands?
Fine
Medium
Coarse
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9
What best describes your hair texture?
Straight
Wavy
Curly
Very curly
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10
What are you hoping to achieve with extensions?
Add fullness
Length 3+ inches
Both
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11
How long do you plan on wearing extensions?
Long enough to get through a phase with my hair
For an upcoming event
Love having them always
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12
Maintenance: Maintaining your investment, we require your extensions to be reinstalled every 6-8-10 weeks. Reinstalls are 270. With proper home care your extension hair can last 8-12 months. If you agree, type agree
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First time extension guests can expect an initial investment of 1,500 + to create the hair you have always wanted! Price is determined by the amount of wefts needed to create your desired look, as well as, how many rows of wefts are necessary to achieve your hair goals, density, color and length. Once this form is completed and submitted, someone will be in touch 24-48 hours to schedule a consultation. At consultation a quote will be given for your hair goals. If you agree, type agree
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14
Appointments with Ansley are scheduled during the week 10-6. The latest appointment is booked at 3:00. Can you make these days and times work?
YES
NO
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15
We want to try to help you achieve your hair goals, around your budget. What is your hair budget for your investment in you? We have different hair types and can give different quotes depending on this helpful information!
1,500, 2,000, 2,500, 3,000, 3,500, etc. . . .
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16
Front photo of your hair.
Please upload photos of your current hair so we can begin the process of your consultation. For photos of your hair, please have someone else take the photos, no selfies. Front picture your current hair so we can begin the process of your consultation. For photos of your hair, please have someone else take the photos if possible, no selfies.
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17
Side photo of your hair.
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Max. file size
: 10.6MB
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18
Back photo of your hair.
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: 10.6MB
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19
Now let’s see your hair inspiration
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Now let’s see your hair inspiration
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: 10.6MB
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21
Signature
After reading this are you ready to commit to doing your part and have your dream hair?!
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22
Signature
Photos from this form won’t be used online. These photos are to help see if you’re a good candidate. Photos in the salon will be what is used online. I can’t wait for us to work together, you’re going to love your new hair! Ansley is an extension specialist and Elite Artist for IBE. She is the only stylist that offers this service at 3BrinSalon. She has two masters degrees with hair. Her masters includes intense studies of haircuts, haircolor, business, technique and of course the healthiest extensions! Now she has also had master 2.0 and has traveled to Utah, Texas, Florida, South Carolina and more. Learning from educators from Canada and many other places she learns to stay in the know for her clients! She exclusively offers Invisible Bead Extensions! This luxury method is created by custom coloring the extensions to blend seamlessly with your natural hair. No tape, glue, bonds, or bulky wefts. Whether you're looking to add volume, length or both, I have you covered with Invisible Bead Extensions®. They are comfortable and invisible, allowing you to confidently rock whatever hairstyle you desire! By signing this form, I am giving consent to have my photos and videos posted on social media, websites and more. Pictures are important for our records and they help encourage others of positivity!
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23
Signature
I agree to be responsible for my hair and hair extensions. I am aware of how to properly take care of my hair and extensions. I HEREBY RELEASE ANDDISCHARGE ANSLEY SCOGGINS, OWNER OF 3BRINSALON FROM ANY AND ALL CLAIMS FOR PERSONAL INJURY, DEATH, OR DAMAGE ARISING FROM OR IN ANY WAY CONNECTED WITH MY HAIR APPOINTMENT IN PARTICIPATION IN THE ACTIVITY. I agree to terms and conditions of the previously listed waiver. I agree to be photographed and or filmed in the course of the activity. I grant full and unlimited permission to Ansley Scoggins/ 3BrinSalon to use my photographs or any other record of participation in this activity in any social media post, broadcast, telecast or other account of the activity for publicity purposes, without compensation.
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