Scalp Ritual Consultation

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Please keep in mind, I am NOT a medical prfessional. If you have extreme hair loss or patchiness, or anything I believe to be a medical condition or needs to be evaluated by one, I will most likely refer you to a professional.
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First Name* This field is required.
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Last Name* This field is required.
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Instagram handle:* This field is required.
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Phone Number* This field is required.
Please enter a valid phone number.
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Email* This field is required.
example@example.com
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Birthdate,* This field is required.
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Why are you booking this service?* This field is required.
Rejuvenation/Relaxation
Determine a scalp care plan to help with scalp issues/ concerns
To help with hair growth
All of the above
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Which scalp concerns are you experiencing?* This field is required.
Dry Scalp
Oily Scalp
Flakey Scalp
Thinning Hair /Loss
Build Up
Other
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When did you first notice this?* This field is required.
Last 3-6 months
6-12 months
1-3 years
3+ years
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Have you seen a dermatologist/specialist about your scalp concerns?* This field is required.
Yes
No
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Are you currently taking any medications-OR recently stopped?* This field is required.
Yes
No
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Do you have any medical conditions I should be aware of?* This field is required.
Yes
No
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Are you on well water?* This field is required.
Yes
No
Not sure
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Are you expecting/nursing?* This field is required.
Yes
No
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Has your bloodwork ever shown any deficiencies?* This field is required.
Yes
No
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What is your current stress level?* This field is required.
1
2
3
4
5
Worst
Best
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How would you rate your general health and fitness?* This field is required.
1
2
3
4
5
Worst
Best
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How often do you wash your hair?* This field is required.
Every day
Every other day
Once a week
Other
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Do you go to bed with your hair wet?* This field is required.
Yes
No
Sometimes
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Do you blow-dry it?* This field is required.
All the time
Sometimes
Never
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Please list any scalp care products or tools you are currently using.* This field is required.
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Have you had lice in the past 6 months? Are you concerned you might have lice now? Please be extremely honest. This not only effects you but myself and other guests.* This field is required.
Yes
No
Possibly have it now
Possibly have had it
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Thank you for considering me for your scalp care needs.I value your health and the safety of our community, and in line with this, I must advise seeking a lice treatment specialist for your recent concern.

I truly empathize with your situation and suggest revisiting our services about 6 months post-treatment, ensuring the utmost care for you and all our clients.

Please feel free to reach out if you need any assistance in the interim. I look forward to welcoming you in the future.

SUGGESTED REFERENCES :

Lice Clinics of America - Fresno (559) 540-8990
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Do you have any sensitivities or allergies to product ingredients? (including essential oils)* This field is required.
Yes
No
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You selected that you have allergies to essential oils. In the Scalp Ritual all the products I use contain essential oils. Please let me know if you'd still like to continue with the service.by clicking yes, you are acknowledging that you are aware that potential allergic reaction may occur if you continue with this service and will not hold Christina Fuentes/Stitch Hair Atelier/ Glo the beauty studio liable.
YESNO
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Any other information you would like to share?* This field is required.
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Would you like some new product recommendations for boosting your scalp health?* This field is required.
Yes
No
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What are the main goals for your scalp today and for the future?* This field is required.
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Do you have concerns about your hair itself, and would you like to address that as well?* This field is required.Deep conditioning treatment/damaged/dry ends hair treatment
Yes
No
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SCALP RITUAL PRICING AND INFORMATION

Thank you for taking an interest in booking with me, Christina.

Right now I am only offering services at my studio locatied inside STITCH. Hair Atelier in Madera Ca.

FIRST TIME & RETURNING GUESTS

You can expect to invest $150-$400+ for us to work together for your scalp health.

This includes standard Scalp Ritual + any add on services you would like (signiture curl style, conditioning treatments eyc) , and products you may need to keep your investment up at home.

I reccomend coming in for treatment maintenance every 6-8 weeks.

*Prices are always subject to change per my reccomendations.
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Having full knowledge of the financial commitment to obtain and maintain your scalp journey, are you prepared to make the financial investment necessary to sit in my hair and receive the Scalp Ritual experience* This field is required.
YES! I can't wait to sit in your chair and pamper myself! I deserve this!
No. I am not prepared to embark on the journey to my dream hair with the scalp ritual.
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Please verify that you are human* This field is required.
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