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SKIN HEALTH QUESTIONNAIRE

Today's Date: October 26, 2021

Please note & initial:

A facial may cause the skin to purge resulting in a break out. This is normal and does not mean you are having a reaction to the products. If you experience any itching, burning, or rash following your facial treatment please notify the professional immediately so he or she can assist you in finding a better product for your skin.

I must notify the professional of any changes to my skin care routine or medications prior to any future treatments.

Oliver Finley Consent

I do hereby acknowledge that I am fully aware that Oliver Finley Academy is a school for Cosmetology and Esthetics, and the students in this school are not held responsible as skilled and trained operators. For that reason, there is a reduction in the prices customarily charged. Therefore, in consideration of the price reduction given for this service, it is agreed and understood that I will in no way hold Oliver Finley, their proprietors, officers, agents, or instructors, or any of its operators liable or accountable for any injury or damage that may occur to me as a result of the services performed in this school. 

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
I certify that I am 18 years of age or older
First Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

AGE

Occupation

MEDICAL INFORMATION

Do you have any current medical conditions?*
No
Yes

If yes, please list:
Do you have any allergies?*
No
Yes

If yes, please list:
Are you taking any medication?*
No
Yes

If yes, please list:
Topical medication?*
No
Yes

If yes, please list:
Have you had any cosmetic surgery/injectable/laser work?*
No
Yes

If yes, please list type & dates:

TELL US ABOUT YOUR SKIN

Have you ever had a facial?*
No
Yes
Do you currently get regular facials?*
No
Yes

How often
Does your skin get oily throughout the day?*
No
Yes
Do you scar easily/keloid?*
No
Yes
Do you smoke?*
No
Yes
Do you drink?*
No
Yes

Glasses of water per day?

Your last sunburn?
Do you use tanning beds?*
No
Yes
Have you ever been treated for?:
Do you react to products?*
No
Yes

If yes, please list:
Are you Pregnant?*
No
Yes
Trying?*
No
Yes
Select your current level of stress:
Select your normal level of stress:
Select how you feel about the overall quality of your skin: 1 is pretty bad, 10 is pretty great.*
Do you exercise?*
No
Yes

If so, How often?

What are your goals for your skin? *
Do you use a cleanser?*
No
Yes

Brand:
Toner?*
No
Yes

Brand:
Exfoliant?*
No
Yes

Brand:
Moisturizer?*
No
Yes

Brand:
SPF?*
No
Yes

Brand:

Other Products Currently Using:
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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