About this template
The Aesthetic Treatment Consent Form is an essential tool for medical spas, dermatologists, and aesthetic practitioners to ensure client safety and professional compliance. This template streamlines the intake process by gathering critical health history, identifying potential contraindications, and securing formal consent before any procedure begins. By moving away from paper-based systems, practitioners can maintain a cleaner, more organized digital record of every client's medical disclosures and signed agreements.
This form covers vital screening areas, including medical history, existing conditions, allergies, and specific treatment risks. It is designed to be sent to clients prior to their appointment, allowing them to review and sign the documentation at their own pace. Using Doc2Form to deploy this template helps you minimize administrative overhead, reduce errors in data collection, and ensure that every client interaction starts with a clear, documented understanding of the aesthetic services provided.
Key features
- Comprehensive medical history and contraindication screening.
- Formal consent and liability waiver sections included.
- Digital signature collection for legal documentation.
- Easily shareable via email or website link.
- Centralized responses in Google Sheets for easy review.
Use cases
- Pre-procedure medical screening for Botox or filler treatments.
- Client liability waivers for chemical peels and facials.
- Documenting patient health history for laser therapy.
- Standardizing intake protocols across multiple clinic locations.
What this form collects
- Full Name (Short answer)Enter your legal name.
- Date of Birth (Date)Format: MM/DD/YYYY
- Are you currently pregnant or breastfeeding? (Multiple choice)Certain treatments are contraindicated during pregnancy.
- Do you have a history of cold sores or herpes simplex? (Multiple choice)This is important for facial treatments.
- Do you have any known allergies? (Paragraph)List any medications, foods, or topical products.
- Informed Consent (Multiple choice)I understand the risks and benefits of the treatment and authorize the practitioner to perform the procedure.
- Client Signature (Short answer)Type your full name to acknowledge that all information provided is accurate and you agree to the terms.
FAQ
Why is this form necessary for aesthetic treatments?
It ensures you have documented proof that the client has disclosed their medical history and understands the risks associated with the treatment, which is vital for professional liability.
Can I add specific questions about my clinic's unique procedures?
Yes, once you convert this template to a Google Form, you can easily add, remove, or edit questions to match the specific requirements of your treatments.
How do I ensure the client has actually signed the form?
You can include a required 'I agree' checkbox or use a text field for the client to type their full name as a digital signature acknowledgment.
Is this form suitable for mobile users?
Yes, Google Forms are fully responsive and work seamlessly on smartphones and tablets, making it easy for clients to complete the form in your waiting room or at home.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.