EmailMe Form - ECS: KERATIN ONLINE CONSULT FORM

ECS: KERATIN ONLINE CONSULT FORM

Hi there! This form is the first step to requesting a Keratin appointment at ECS and should take less than 7 minutes to complete.

This online consultation form helps to give us an idea about your specific hair goals and get you scheduled for the appropriate service(s).

For Textured Hair Types: Wavy-Kinky-Curly-Coily

For FIRST VISIT and EXISTING CLIENTS we HAVE NOT SEEN within 4+ MONTHS

If you are NEW or It has been 120 days or more since your last visit, you'll need to COMPLETE THIS FORM.

- Your request will be review within 24- 72 Business hours and we will send you a Text message and/or email upon completion of this form

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 JHST service with us.
Name *
First Last
Email *

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

Confirm
### - ### - ####
What is your Home or Shipping Address? *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
What is the age of the person receiving the Hair Smoothing (Keratin) service? *
If under 18 or 21, list age and date of birth below
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
CLIENTS UNDER THE AGE OF 17 MUST COMPLETE THIS FORM AND ALSO COMPLETE OUR ONLINE PARENT CONSENT FORM.

BOTH FORMS MUST BE SUBMITTED PRIOR TO AN APPOINTMENT
If under 18 or 21, list age and date of birth. *
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? *
TikTok
Google Review
Google Search
Yelp
Instagram
Referral
Facebook
Other, please list Referral Name here
If referred by a friend/client of ECS, please specify first and last name so we can thank and reward them for their referral.
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
Are you coming to Arizona for your Keratin Treatment service or do you want us to travel to you for your Keratin Treatment service? * *
Type N/A if this does not apply to you
If you want Ms. CeCe to travel to you for your Keratin Treatment service, please list your City, State, and Zip Code. *
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
Gender Identity of the person receiving services *
Male
Female
NON-BINARY
REQUESTED KERATIN SERVICE
We offer several Keratin (Hair Smoothing) Systems. Please check which Keratin Treatment you would like to schedule.

ALL HAIR SMOOTHING (KERATIN) PRICES LISTED ARE STARTING PRICES AND BASED ON LENGTH, DENSITY AND REQUIRED PRODUCT USAGE.

An estimate/quote will be emailed to you based on the hair assessment from the completed Keratin Consultation Form.
Which Keratin (Hair Smoothing) service would you like to schedule? *
AVLON TEXTURE RELEASE
BRAZILIAN BLOW OUT | ADULT [$175 - $375+]
BRAZILIAN BLOWOUT | TWEEN [$150 - $350+]
DESIGN ESSENTIALS STS TREATMENT
EBO - EXPRESS BLOW OUT | [$75+]
KERATIN COMPLEX PBO | TWEEN [$150 -$345+]
KERATHERAPY | ADULT [$175 -$395+]
KERATIN COMPLEX PBO | ADULT [$175 -$395+]
KERATIN COMPLEX PBO | TWEEN [$150 -$345+]
NKST - NATURAL KERATIN SMOOTHING TREATMENT [$225 - $350+]
SILK OUT TAMINING TREATMENT
YUKO ANTI-FRIZZ
TWEEN SERVICES: Ages 6-12

KCPBO: Lasts up to 3 months
KCSMOOTH: Lasts up to 3 months
KCNKSTB: Blonde Hair Enjoy up to 5 months of smooth
KCMAX: lasts up to 3 months.
KCNKST: Enjoy up to 5 months of smooth
KCTEXTURE: Curl Enhancing Keratin - Last up to 3 months
Please write down any questions or concerns you may have for the stylist about your Keratin Treatment service. *
Type N/A if this does not apply to you
HAIR TEXTURE - TYPES - DIFFERENCES
What is your Ethnicity? *
African American
Asian
Bi-Racial
Caucasian
Hispanic
Indian
Other, please explain
This will assist us in assessing your hair type.
What best describes your natural, un-treated, air-dried hair texture? *
Slightly Wavy
Wavy
Curly
Super Curly
Coily
Kinky
Type 2 - Wavy (like a loose S)
Type 3 A Loose Curly
Type 3B Defined med. springy curls
Type 4A -Coily, springy curls
Type 4C -Tight Zigzag
Type 4B - Moderate Zigzag coils
Type 3C Corkscrew curls
Kinky-Curly
Other
Please select the option that best describes your hair texture
CURRENT HAIR LENGTH
LENGTH: How long is your hair when stretched? Please follow Measuring instructions below. *
SHORT: Above chin/nape
SHORT: between nape & mid neck
SHORT: Above shoulders
SHORT: Touching shoulder
MEDIUM: Below shoulder
MEDIUM: Touching shoulder blade
MEDIUM: Below Shoulder Blade
LONG: Touching Bra-line
LONG: below bra-line to 2 inches
LONG: Waist Length to 2 inches
HOW LONG DOES YOUR HAIR NEEDS TO BE TO GET A KERATIN TREATMENT?
Your hair must be at least 4 inches long to receive this service

HOW TO MEASURE YOUR HAIRS' LENGTH
To accurately measure your hairs’ length, use FLEXIBLE MEASURING TAPE.

Place the measuring tape at back of your head below the cranial bone. Secure the measuring tape with a bobby pin or clip. Stretch your hair alongside the length of the tape in order to find your hairs’ length inches or centimeters.

Please select the correct length as pricing will be adjusted based on actual Measurements at the time of service.
CURRENT HAIR DENSITY
DENSITY: Select your hairs' correct density. Please follow the Measuring instructions below *
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 top project an ESTIMATED PRICE and allocate and anticipate the AMOUNT OF TIME your Keratin service may REQUIRE.
CURRENT HAIR CONDITION
My hair is: *
Virgin
Relaxed
Color Treated
Permanently Waved
My hair is: *
Weak
Dry Brittle
Damaged
Over Processed
Shedding
My hair is: *
Normal/Healthy
Some breakage
Damaged
Severely Damaged
Heat Damaged from Irons
Breaking off
Faling out
Thinning
Shedding
Has Build up
Dry and Dull
Frizzy
Limp
Heavy
Oily
Postpartum
Post-Chemo
Knotted/Matted
If damaged, tell us more about the damage. How did it happen? Where is it? How are you treating it? etc... *
Type N/A if this does not apply to you
Explain how often you straighten, flat iron, or use heat to style your hair? *
Type N/A if this does not apply to you
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
When was your last Deep Conditioning Treatment and what brand did you use? *
NOTE: Some products can be incompatible with professional chemicals, so please be as honest and transparent as possible.
When was your last Protein Treatment and what brand did you use? *
NOTE: Some products can be incompatible with professional chemicals, so please be as honest and transparent as possible.
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
Currently I am experiencing: *
Breakage
Brittleness
Damaged Strands
Dryness Hair
Falling Out
Frizzy
Hair Style needs Shaping
Limp curls
Shedding
Split Ends
Transitioning hair
Unmanageable hair
Other
HAIRLINE: Is your hairline... *
Healthy
Thinning
Bald on Both sides
Bald on One side
If Bald, please explain
HAIRCUTS AND TRIMS
When shampooing your hair do you experience hair balls/hair strands on the shower floor or sink? *
Yes, Sometimes
All the time
Not often
If yes, please explain
Does your hair become knotted or tangled? *
Yes, Sometimes
All the time
No, not at all
Not often
If yes, please explain
How often do you receive a HAIRCUT OR TRIM? *
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.

A HAIR TRIM maintains the style and shape of a HAIRCUT as well as removes split ends
When was your last hair cut or trim? *
Who did your last cut or trim? *
I cut it myself
A professional licensed stylist
A Spouse, Relative or Friend
When was your Last professional trim by a Licensed Hair Stylist? *
What is your ideal Hair Cut length? *
KERATIN GOALS
What are your Keratin Treatment goals? *
Strengthen hair
Completely Frizz Free hair
Manageable hair
Hair Growth
Curl Definition
Reduced Styling time
Decrease Blow Dry Time
Reduce Frizz
Versatility between Straight & Curly Styles
Please list other Keratin goals here *
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 RETOUCHES
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?
CHEMICALS
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.
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
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 *
CURRENT PHOTOS
***IMPORTANT***
Instructions for Uploading Your Current Photos

1. Use your cell phone, as professional camera images may be too large to upload.
2. For best results, ask someone to take the photos for you.
3. Take the photos indoors in natural lighting (avoid flashes and direct sunlight).
4. Submit recent photos that clearly show your true hair length and texture.

Uploading accurate photos helps us assess your hair's current condition and provide an accurate estimate for pricing and service time.

***IMPORTANT***
Please refrain from submitting photos of your hair in braids, ponytails, wigs, or similar styles. We need to see your natural hair length, density, and condition for evaluation. Any photos that do not clearly showcase these will not receive a quote or estimate, wasting both your time and the stylist's. Thank you for your understanding!
Please attach 4 recent photos of your hair in its natural state (not straightened, no braids, twist, extensions, etc.) Include front view, right and left side views and back view.
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
If there is no availability of the date/time you request, we will TEXT or EMAIL you with alternatives and/or offer to add you to OUR KERATIN WAITLIST.
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
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 Payment Plan via AfterPay – Split service(s) into 4 interest-free installments
Pay my Keratin Treatment in Full now via PaySimple
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.
KERATIN PRODUCT USAGE BREAKDOWN

Starting Keratin prices are for chin length hair of average density. Price increases based on length, density and required product usage for proper saturation.

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

REQUESTED KERATIN SERVICE

HAIR TEXTURE - TYPES - DIFFERENCES

CURRENT HAIR LENGTH

CURRENT HAIR DENSITY

CURRENT HAIR CONDITION

HAIRCUTS AND TRIMS

KERATIN GOALS

KERATIN HISTORY

KERATIN RETOUCHES

CURRENT SCALP HEALTH

CHEMICALS

HEAT & YOUR HAIR

CURRENT HEALTH

CURRENT PHOTOS

YOUR AVAILABILITY

KERATIN TREATMENT PAYMENT OPTIONS

CONSULTATION PURPOSE

KERATIN PRODUCT USAGE BREAKDOWN

HAIR SMOOTHING (KERATIN) RETOUCH