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WAXING QUESTIONNAIRE

Today's Date: July 25, 2021

Please note & initial:

Waxing may cause: Bruises, scabs, scarring, redness, hyperpigmentation, pimples or a flare up of any of the above mentioned conditions / responses.

I understand that if I have Herpes or Staph/MRSA, I may experience an outbreak after the waxing service. The professional has explained the best way to minimize or prevent an outbreak when waxing regularly.

I understand I may carry Herpes and/or Staph/MRSA without any physical symptoms or a medical diagnosis. I also understand that the waxing service does not allow the opportunity to contract these conditions from my technician.

I understand all of the above mentioned reactions. I also understand if I change my skin care routine or medications I must inform the professional PRIOR to any service in the future.

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*
First Client's Information

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
First Client's Signature*
Second Client's Name

First Name*

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

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
Third Client's Name

First Name*

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

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
Fourth Client's Name

First Name*

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

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
Fifth Client's Name

First Name*

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

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
Sixth Client's Name

First Name*

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

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
Seventh Client's Name

First Name*

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

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
Eighth Client's Name

First Name*

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

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
Ninth Client's Name

First Name*

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

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
Tenth Client's Name

First Name*

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

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
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*
Parent or Guardian's Information

WHAT BODY PART(S) ARE WE WAXING TODAY?

WHEN DID YOU LAST SHAVE OR TRIM?
HAVE YOU BEEN WAXED BEFORE?*
No
Yes

IF "YES", WHEN?
ARE YOU USING/TAKING ANY OF THE FOLLOWING?*
Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners
NOT APPLICABLE
Do you have any tendencies towards?*
Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis
NOT APPLICABLE
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST

MEDICAL INFORMATION

Have you ever been treated for?:

OTHER INFORMATION
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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