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TINTING QUESTIONNAIRE

Today's Date: May 26, 2022

Please note:

I understand that tinting lashes or brows has some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging or burning, blurry vision and potentially blindness, should the tint enter the eye. 

I understand that if the tinting agent, developer, or mixture of both accidentally comes into contact with my eye, my eye will be flushed with water and medical attention may be required.

I understand that some irritation, itching or burning may occur to the skin which comes in contact with the tinting agent. 

I understand that there may be some residual dark staining left on the skin following the tinting process of either my lashes, brows or both. This will fade and go away within a short time. 

I understand that, while every attempt will be made to provide me with my chosen color, everyone's hair absorbs color differently and my final results may not be the color I initially wanted. 

I undersand that over the course of several weeks, the tint will gradually lighten and fade. Re-tinting will be required to keep the new color fresh. Most clients need to re-tint every 3-4 weeks. 

I have read the above information. If I have any concerns, I will address them with my esthetician. I give permission to my esthetician to perform the tinting procedure we have disucssed, and will hold him/her and his/her staff harmless from any liability that may result from this treatment. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. 

 

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
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
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
Have you ever used hair color before?*
No
Yes
Have you ever had an allergic reaction to hair color?*
No
Yes
Have you ever had your brows or lashes tinted before?*
No
Yes

If you've had an adverse reaction to tinting before, please explain...
Do you have any allergies?*
No
Yes

IF "YES", PLEASE LIST
Do you wear contacts?*
No
Yes

Please list any illnesses or conditions you are being treated by a physician for.
Have you ever been treated for:
I have accurately answered the questions above.*
No
Yes
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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