EmailMe Form - ECS: KERATIN ONLINE CONSULT FORM

ECS: KERATIN ONLINE CONSULT FORM

This consultation form is for:
FIRST VISIT & RETURNING KERATIN TREATMENT CLIENTS

Thank you so much for you interest in a Keratin Treatment from Endless Creations Salon.

CURRENT OPEN HOURS
Tuesday — Friday 9:00a — 7:00p
Saturday 8-a - 4pm

OPEN SUNDAY HOURS (2) Sundays Monthly (dates vary)
GENERAL SERVICES: Sunday 9am-1pm by appointment ONLY

PREMIUM & SPECIALTY PREMIUM SERVICES: SUN OR MON Start time may vary.

Once you have completed this form, we will review your form and reply via email with a quote, along with some information about the requested appointment times.

TEXT US: 480-485-4413 Tue - Sat | 8a – 4p Messages checked periodically.

EMAIL US: info@endlesscreationssalon.com

PERSONAL INFORMATION
We are excited to have the pleasure of serving you and we appreciate you taking the time to answer our Consultation questions before your Keratin Treatment appointment with us.
Name *
First Last
Please list your Email address *

Confirm
Please list your phone *
### - ### - ####
Home or mobile number, whichever is best to reach you.

Confirm
### - ### - ####
What is the age of the person receiving the Hair Smoothing (Keratin) service? *
Under 18
Under 21
In my 20s
In my 30s
In my 40s
In my 50s
In my 60s
In my 70s
In my 80s
In my 90s and up
If under 18 or 21, list age and date of birth. *
Gender Identity of the person receiving services *
Male
Female
NON-BINARY
What is your occupation? *
Ex. Student, Retired, Nurse, etc.
Occasionally, we may send out emails or newsletters about upcoming discounts, promotions, company information etc.

If you would like to be added to the subscriber list please check “Yes” below. If you would like to opt out please check “No”. *
Yes
No
HOW DID YOU HEAR ABOUT US? *
Current Client
Facebook
Google Review
Google Search
Instagram
Instagram - Specific Stylist Page
Internet Search
Referral
Other
CLIENT STATUS
I am a *
FIRST VISIT (NEW CLIENT: 0 VISITS)
EXISTING CLIENT (LAST VISIT WITHIN 4 MONTHS)
RETURNING CLIENT (LAST VISIT BETWEEN (4-11 MONTHS)
RETURNING CLIENT (12 + MONTHS ago)
VISITING CLIENT (OUT OF TOWN NEW CLIENT)
VISITING CLIENT (OUT OF TOWN RETURNING CLIENT)
Visiting Client: Please list your current City and State *
Type N/A if this does not apply to you
I am scheduling a Hair Smoothing (Keratin) Treatment for: *
Myself
My Child
My Grandchild
My Foster Child
My Friend
Other
Name of the person receiving a Keratin Treatment: *
First Last
How often do you visit hair salons? *
Every 1-2 weeks
Every 3-4 weeks
Every 3-4 months
Every 6 months
Every year
Hardly ever
When was your Last professional salon visit? And, what service(s) did you receive? *
Type N/A if this does not apply to you
HAIR TEXTURE - TYPES - DIFFERENCES
What is your Ethnicity? *
Caucasian
African American
Asian
Bi-Racial
Hispanic
Indian
Other
This will assist us in assessing your hair type.
What is your Curl Pattern? *
Straight
Wavy
Curly
Coily
Kinky
Mixed | Combination
Please select the option that best describes your hair texture
What is your degree of curl?: *
Slight to Minimal Wave
Open Loose Wave
Very Wavy
Curly
Loose Curls
Very Curly
Spiral Curls
Corkscrew Curls
Coily
Very Coily
Z-Coils
Tight Coils
Please select the option that best describes your hair texture
Define your hair texture? *
Fine
Medium
Coarse
Please select the option that best describes your hair texture

FINE: Fine strands appear to be thin and may not hold styles well.

MEDIUM: Medium strands appear full and hold styles well.

COARSE: Coarse strands are very full and hold styles well.
What are your Keratin Treatment goals? *
Strengthen hair
Frizz Free hair
Manageable hair
Hair Growth
Curl Definition
Reduced Styling time
Cut Down Drying Time
CONDITION: What is the current condition of your hair? *
Breakage
Brittleness
Damaged Strands
Dryness Hair
Falling Out
Frizzy
Hair Style needs Shaping
Limp curls
Shedding
Split Ends
Transitioning hair
Unmanageable hair
Other
Does your hair become knotted or tangled? *
Yes, Sometimes
All the time
No, not at all
Not often
If yes, please explain
Do you feel like your hair is shedding/thinner more than usual lately? *
No, seems normal
Sometimes it seems to shed more than usual
Yes, lately it has been shedding alot
If yes, please explain
LENGTH
LENGTH: How long is your hair?
Please check the hair length that most accurately describes the length of your hair. *
XXSHORT | ABOVE CHIN/NAPE
XSHORT | BETWEEN NAPE & MID NECK
SHORT | TOUCHING SHOULDER & ABOVE
MED LONG | BELOW SHOULDER
LONG | TOUCHING SHOULDER BLADE
XLONG | BELOW SHOULDER BLADE
XXLONG | TOUCHING BRA-LINE
XXXLONG | BELOW BRA-LINE TO 2 INCHES BELOW
XXXXLONG | WAIST LENGTH TO 2 INCHES BELOW
HOW LONG DOES YOUR HAIR NEEDS TO BE TO GET A KERATIN TREATMENT?
Your hair must be at least 4 inches long to receive a Keratin (Hair Smoothing) service.

HOW TO MEASURE YOUR HAIRS' LENGTH
To accurately measure your hairs’ length, use a flexible measuring tape. Place the measuring tape at your scalp and stretch your hair alongside the length of the tape in order to find your hairs’ length inches or centimeters.

NOTE: Curly & Coily Textured hair grows big before it grows long.
When the curly & coily textures are stretched out fully the true length of the hair is revealed.

Please select the correct length as pricing will be adjusted based on actual length at the time of service.
SHAMPOO: How often do you shampoo your hair? *
Every day
Once a week
Every other week
2-3 times per week
Once per month
Other
CONDITION: What’s your conditioning regime? *
Deep Conditioner no heat
Deep conditioner with heat (dryer or steamer)
Quick conditioner (rinse off in a few minutes)
Leave - in conditioner
No conditioner
Other
Please list Shampoo(s) and Conditioners you currently used at home *
Type N/A if this does not apply to you
How often do you have hair Treatment(s)? And, when was your last treatment? *
Deep Conditioners, Proteins and Masque Treatments.

Type N/A if this does not apply to you
Explain your hair care and conditioning regimen? *
Do you generally get.... *
Professional Hair Care by a Licensed Stylist
Do-it-youself
Go to a Braider/Weave
Go to an Unlicensed Stylist/Friend/Relative
HAIRLINE: Is your hairline... *
Healthy
Thinning
Bald on Both sides
Bald on One side
If Bald, please explain
DENSITY
How dense is your hair? *
Yes, I can see a lot of my scalp
I can see a bit of my scalp
No, I can't see my scalp unless I pull the two sections of hair apart
Other
If you look at the top of your head, where your parting is, can you see your scalp?
SELECT THE CORRECT HAIR DENSITY. What is your actual Hair Density? *
Circumference of 3 inches
Circumference of up to 3+ inches
Circumference of 4 inches
Circumference of 5 inches
Circumference of 6 inches
Circumference of 7 inches
Circumference of 8 inches
Circumference of 9 TO 11 inches
Circumference of 12-14 inches
FOLLOW THE INSTRUCTIONS BELOW FOR AN ACCURATE READING
- Place your hair into a ponytail using a ponytail holder (wrapping 2x's).
- Wrap a flexible tape measure around the base of your ponytail (this reveals your hairs' density).

HD - High Density Hair requires more time and product usage.

This helps us to QUOTE CORRECT pricing and allocate and anticipate the amount of time and product usage your GinaCurl service may be.

This helps us to QUOTE CORRECT pricing and allocate and anticipate the amount of time your Hair Smoothing (Keratin) Treatment service may be.
HAIRCUTS AND TRIMS
How often do you receive a HAIRCUT? *
Every 3-4 weeks
Every 4-5 weeks
Every 6-8 weeks
Every 8-10 weeks
Every 10- 12 weeks
Other
A HAIRCUT is changing shape of your hair completely.
How often do you TRIM you ends? *
Every 3-4 weeks
Every 4-6 weeks
Every 6-8 weeks
Every 8-10 weeks
Every 10- 12 weeks
Other
A HAIR TRIM maintains the style and shape of a HAIRCUT as well as removes split ends
When was your Last professional trim by a Licensed Hair Stylist? *
If you HAIRCUT/TRIM AT HOME, when was your last haircut/trim? *
Type N/A if this does NOT apply to you
What is your ideal Hair Cut length? *
CHEMICALS
When was your hair last chemically straightened *
Never
3-6 MONTHS AGO
ABOUT 1 YEAR AGO
ABOUT 2 YEARS AGO
Other
Keratin Treatments can be applied to Chemically Treated hair.

We need your chemical history to determine a suitable Keratin service.
Is your hair color-treated? *
Yes, my hair is colored but not lightened
Yes, my hair is lightened
No, my hair is its natural color without any enhancements
If any part of your hair has been lightened or darkened from your natural color, answer yes.
Do you currently have ANY COLOR that has been applied to your hair within the past 2 years? If so, please describe what and when for each *
(i.e. Box Color, professional color, rinses, glosses, henna, highlights, lowlights, henna, etc.
Do you currently have ANY CHEMICAL(s) that has been applied to your hair within the past 2 years? If so, please describe what and when for each *
RELAXER, TEXTURIZER, CURLY PERM, PERMANENT COLOR, DEMI-PERMANENT COLOR, HIGHLIGHTS, BLONDING, BALAYAGE ETC.

TYPE N/A IF NOT APPLICABLE
Have you ever had problems with chemical services? *
(i.e. breakage, sensitivity, resistant areas, etc.)
Is there any over-the-counter chemical product currently on your hair? If yes, please explain *
HEAT & YOUR HAIR
Would you say your hair is heat-damaged, or your natural texture is compromised due to flat ironing, blow drying or any other heat-styling? *
Yes, my hair is damaged due to heat
No, my texture is intact
I’m unsure
Other
How Often do you straighten, flat iron, or use heat to style your hair? *
Daily
Every other day
3x a week
2x a week or less
Other
KERATIN HISTORY
Have you ever had a Keratin Treatment service on your hair? Yes or No? If yes When? Where? What brands? How long ago? And, what was the RESULTS *
If no, type N/A
KERATIN GOALS
What is your desired Keratin style/result? *
Sleek & Straight
Defined Curls
Perfect Waves
Improve manageability
Reduce Frizz
Soften Curl Pattern
Decrease Blow Dry Time
Smooth Texture
Reduce Volume
Enhance Curl Definition - keep my curls, but reduce volume
Versatility between Straight & Curly Styles
Frizz Control - 30 - 40 % Curl Reduction
Ultimate Smoothness - 70 % Curl Reduction
Maximum Straightness - 90 % Curl Reduction
Temporarily Straight for about 1 month
To have a Keratin Reparative Treatment to Restore my hair
Undecided, I need an in-person consultation
If you need an in-person consultation, TEXT US to book an In-Person Keratin Consultation @ 480-485-4413.
We offer several Keratin (Hair Smoothing) Systems. Please check which Keratin Treatment you would like to schedule. *
Avlon Texture Release
Brazilian Blowout
Design Essentials STS
Keratherpy Extreme
KCEXPRESS: Lasts up to 6 weeks.
KCPBO: Lasts up to 3 months
KCSMOOTH: Lasts up to 3 months
KCMAX: lasts up to 3 months.
KCNKSTB: Blonde Hair Enjoy up to 5 months of smooth
KCNKST: Enjoy up to 5 months of smooth
KCTEXTURE: Curl Enhancing Keratin - Last up to 3 months
Keratin Treatments can last up to 3- 5 months depending on the Keratin Treatment System you use. Realistically, how often do you want to retouch your Keratin Treated hair? *
If no, type N/A
Would you like to add-on other services to your Hair smoothing (Keratin) Treatment service? *
Semi-permanent or Demi-permanent Hair color can be used with a Keratin Treatment Same Day.

Add-On services: Olaplex, Trim, HairCut, Semi or Demi Color, etc.
CURRENT SCALP HEALTH
Is your scalp itchy or flaky? *
Yes, Itchy
Yes, Flaky
Yes, Itchy and Flaky
No
I am not sure
Do you have any hair loss problems now or in the past? *
Is hair loss a genetic issue in your family?
CURRENT HEALTH
Have you taken any type of medication in the past six (6) months? If yes, please list *
Have you gone through menopause or could be pre-menopausal? *
Yes
No
Are you currently pregnant or have given birth in the past year? *
Yes
No
Have you had any surgery that required general anesthesia in the past year? *
Yes
No
Please list any known allergies *
List all current Medications. If no medication, type N/A *
HAIR SMOOTHING (KERATIN) TREATMENT & ANTI-FRIZZ PRICING

ALL HAIR SMOOTHING (KERATIN) PRICING IS BASED ON LENGTH, DENSITY AND PRODUCT USAGE.

Please visit our Website for current pricing or TEXT our Client service coordinator at 480-485-4413.
PHOTOS

SUBMIT A RECENT PHOTO OF YOUR HAIR IN IT’S NATURAL STATE

Please upload 4 photos of your hair.

1. Front
2. Back
3. Right Side
4. Left Side

Take the photos in front of a white or light colored wall in a white or light T-shirt (for easy visibility).

ALL PHOTOS MUST BE NECK UP *

Add File

IN SALON PHOTOS
- Please note that photos/videos of the hair and your face will be taken for Hair Goals Growth journey and/or promotional purposes.

ALTERNATE PHOTOS SUBMISSION:
If your photo files are too large to send using this consultation form, please fill out an e-mail to appointmentdesk@endlesscreationssalon.com

After reviewing the photos and based on your requirements from the consultation form we will send you a quote and be able to answer your questions on a personal level.
Please upload photos of how you want your Hair Smoothing (Keratin) Treatment to look like

Add File
YOUR AVAILABILITY
How soon would you like your Hair Smoothing (Keratin) service? *
ASAP - TODAY WOULD BE GREAT
IF SOMEONE CANCELS, CALL ME
SOMETIME THIS MONTH
SOON - WITHIN THE NEXT WEEK
What day of the week works best with your schedule? *
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
What time of day works best with your schedule? *
MORNINGS 8 AM START TIME
MORNINGS 9 AM START TIME
MORNINGS 10 AM START TIME
LATE MORNING 11 AM START TIME
EARLY AFTERNOON 12 - 1PM START TIME
LATE AFTERNOON 2PM START TIME
EARLY EVENING 3- 4PM START TIME
LATE EVENING 5-6PM START TIME
Request a date for service *
MM / DD / YYYY
SCHEDULING YOUR KERATIN) TREATMENT
Appointments for a Hair Smoothing (Keratin) services are currently available on Tuesdays - Saturdays.

CONVENIENCE FEES
If you would like to schedule a Keratin Treatment on an alternative day and/or time OUTSIDE of regular business hours a $75 convenience fee is required.

We will then try to accommodate your request
based our current availability.

If there is no availability of the date/time you requested, we will TEXT or EMAIL you with alternatives and/or offer to add you to OUR KERATIN WAITLIST.
OTHER APPOINTMENT PREFERENCES *
LIST DETAILS IN COMMENT BOX - BE SPECIFIC
- Requests or restrictions:
- Any other information that may be helpful in booking your appointment.
KERATIN TREATMENT PAYMENT OPTIONS

Please note that we do require Full Payment or a payment plan to secure Keratin Treatment reservations that are non-refundable and non-transferrable.

Flexible Payment Plans Available options listed below

We offer multiple payment options for the cost of your Keratin Treatment Service
Select which payment option works best for you. *
Pay my Keratin Treatment In Full now via Zelle
Pay my Keratin Treatment in Full now via PaySimple
Pay my Keratin Treatment Payment Plan via AfterPay – Split service(s) into 4 interest-free installments
Pay my Keratin Treatment Payment Plan via Sezzle Pay - Split service into 4 installments
Pay my Keratin Treatment Payment Plan via CherryPay – Apply for a specific dollar amount
After submission of this form you will RECEIVE A QUOTE with the ESTIMATED Total cost of your Keratin Treatment Service(s) within 2-4 business days.

Ensure you are registered for a payment Plan at least (3) business days prior to the scheduled appointment in order for the appointment slot to be secured.

Text our Client Service Coordinator (Jay) at 480-485-4413 for GinaCurl booking assistance or a Custom Payment Link.
CONSULTATION PURPOSE
The purpose of this Consultation is to make your Keratin Treatment service as successful as possible.

We are looking for length, condition, texture and previous chemicals in the hair. Be as honest and thorough as possible to prevent any adverse reactions to this Keratin service.
PRODUCT USAGE

StartingKeratin prices are for chin length hair of average density. Price increases based on length and density.

EXTRA BOWL(S) OF KERATIN

SHORTER HAIR LENGTHS - .5 OZ OF Keratin Solution Included - Extra Keratin is charged $50 per .5 OZ

MED - LONG HAIR LENGTHS - 1 OZ OF Keratin Solution Included - Extra Keratin is charged $50 per .5 OZ

CURLY TEXTURED HAIR
ALL LENGTHS - 2OZ OF Keratin Solution Included - Extra Keratin is charged $50 per .05 OZ

The same amount of Solution is allotted for every client based on the hair’s length. If more solution is necessary, you will be charged for additional bowls of solution. This covers extra product costs.

The base price for the smoothing treatment is based on the manufacturer's recommended amount of product.
HAIR SMOOTHING (KERATIN) RETOUCH
A Re-touch Application is recommended Every 3-5 months

A Trim Regimen of 10-12 weeks is also highly recommended to reduce shedding and split ends

Hair Smoothing (Keratin) Treatment Release Form

In order to ensure a quality service, please read, initial and sign and date the following statements. *

I acknowledge that this is a virtual hair analysis and consultation with a Keratin Certified Hair Stylist.
I have provided all information regarding previous treatments to my hair and/ or color that may or may not affect the outcome of my service.
I understand Failure to provide true or accurate information can result in possible damage to my hair as well as lack of treatment consistency or effectiveness.
I understand that My stylist will explain to me the process they recommend for my hair type, texture, condition and desired results.
I understand that Keratin Treatments are designed to minimize frizz while enhancing the appearance of the natural wave/curl.
I understand that I will be given aftercare instructions and product recommendations to best care for, preserve and prolong my Keratin treatment results.
I understand that a Keratin Treatment is not a chemical relaxer or chemical straightener, and that Endless Creations Salon, and any affiliates do not guarantee straight hair by performing this service.
I am not pregnant or nursing, and I have advised my stylist of any potential concerning medical conditions including asthma or respiratory disease.
I release my stylist, Endless Creations Salon and any affiliates from any liability during or after my Keratin treatment.
I agree to all aftercare instructions and understand that my Keratin service is non-refundable and non-negotiable

Date Time *
MM / DD / YYYY
Signature *
Clear

PERSONAL INFORMATION

CLIENT STATUS

HAIR TEXTURE - TYPES - DIFFERENCES

LENGTH

DENSITY

HAIRCUTS AND TRIMS

CHEMICALS

HEAT & YOUR HAIR

KERATIN HISTORY

KERATIN GOALS

CURRENT SCALP HEALTH

CURRENT HEALTH

HAIR SMOOTHING (KERATIN) TREATMENT & ANTI-FRIZZ PRICING

YOUR AVAILABILITY

SCHEDULING YOUR KERATIN) TREATMENT

KERATIN TREATMENT PAYMENT OPTIONS

CONSULTATION PURPOSE

PRODUCT USAGE

HAIR SMOOTHING (KERATIN) RETOUCH