EmailMe Form - ECS: KERATIN ONLINE CONSULT FORM

ECS: KERATIN ONLINE CONSULT FORM

This consultation form is for:
FIRST VISIT & RETURNING CURLY CUT 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: appointmentdesk@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)
Welcome Back Client (4+ months since last Visit)
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
CONDITION: What is the current condition of your hair? *
Damaged Strands
Unmanageable hair
Transitioning hair
Limp curls
Dry Hair
Frizzy
Breaking Off
Shedding
Falling Out
Split Ends
Hair Style needs Shaping
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
LENGTH
- Your hair must be at least 4 inches long to receive this service.
- Pricing on services rendered can and will be adjusted based on appropriate Length, Density (thickness), and Product usage upon check-out.

LENGTH IS DETERMINED BY THE NATURAL LENGTH OF HAIR WHEN THE HAIR IS STRETCHED OUT (ELONGATED).

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.
- Wrap a flexible tape measure around your ponytail (this reveals the circumference of your ponytail.

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 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 different Keratin Treatment Systems. Please list which Keratin Treatment you would like to schedule. *
- Brazilian Blowout
- Keratherapy | Extreme
- Keratin Complex | EBO | PBO
- Design Essentials STS
- Yuko Anti Frizz
- SilkOut Taming Treatment
Keratin Treatments can last up to 3 months. How often do you want to retouch 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 ARE THE BEST DAYS FOR AN APOINTMENT *
WHAT DAY(S) ARE BEST FOR YOU FOR YOUR KERATIN TREATMENT AND TIME OF DAY DO YOU PREFER? *
DAY | MM/DD/YYYY
TIME | HH | MM | AM/PM
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 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 PERMANENT WAVE WAITLIST.
HAIRSMOOTHING (KERATIN) TREATMENT COMMENT BOX *
Anything else you want us to know

We reply to you VIA EMAIL within 1-3 business days. and will provide you with a personalized quote.
FLEXIBLE PAYMENT OPTIONS

Flexible Payment Plans Available

We are pleased to offer our clients a convenient way to pay for all their treatment need. Copy & paste the following link to submit the deposit

SPECIALTY SERVICE DEPOSIT: a $85 - $95 non-refundable, non-transferable deposit is required to hold an appointment slot. The deposit will go towards your final bill.

https://bit.ly/ECSKERATINPBODEPOSIT

BUY NOW, PAY MONTHLY - Make smaller, more manageable monthly installments with Cherry Pay or Sezzle Pay. Copy & Paste the following links to learn more and apply.

CHERRY PAY: https://bit.ly/CHERRYCALC
SEZZLE PAY: https://bit.ly/FVKERASEZZPAYPKG

Upon submission of your deposit, please send a screenshot of your confirmation page to our Textline at 480-485-4413 to finalize your booking request
Select which payment option works best for you. *
Pay my Keratin Treatment Specialty Service DEPOSIT & pay my balance on the day of service upon arrival
Pay Full Price now
Payment Plan Option - pay in installments
We offer multiple payment options to help with the cost of your Hair Smoothing (Keratin) Treatment service.

Copy & paste the following links to learn more and apply.
CHERRY PAY: https://bit.ly/CHERRYCALC
SEZZLE PAY: https://bit.ly/FVKERASEZZPAYPKG

Text our Client Service Coordinator (Jay) at 480-485-4413 and request DEPOSIT OR PAYMENT PLAN 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 - 2 OZ OF Keratin Solution Included - Extra Keratin is charged $50 per .5 OZ

The base price for the smoothing treatment is based on the manufacturer's recommended amount of product. Most clients will not need extra product
HAIR SMOOTHING (KERATIN) RETOUCH
A Re-touch Application is recommended Every 3-4 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

FLEXIBLE PAYMENT OPTIONS

CONSULTATION PURPOSE

PRODUCT USAGE

HAIR SMOOTHING (KERATIN) RETOUCH