About this template
The Aromatherapy Client Intake Form is an essential digital consultation tool designed for wellness practitioners, spas, and holistic therapists. Before administering any treatment, practitioners must understand their client's wellness goals, preferences, and medical background to ensure safe and effective care. This comprehensive intake form collects vital personal details alongside detailed medical histories, contraindications, current medications, skin sensitivities, and specific aromatherapy preferences or aversions.
By gathering this critical health data in advance, practitioners can identify potential risks—such as allergies, high blood pressure, epilepsy, or pregnancy complications—that might conflict with essential oils or specific massage techniques. The template streamlines your onboarding workflow, replacing cumbersome paper clipboards with a secure, mobile-friendly digital experience that clients can complete before arriving at their appointment. Utilizing Doc2Form, you can instantly turn this structured layout into a ready-to-use Google Form, saving valuable administrative time and ensuring every session starts with complete clarity and safety.
Key features
- Collect complete health histories and medical contraindications before treatment.
- Identify preferred and non-preferred essential oils or scents instantly.
- Screen for critical risk factors like allergies, sensitive skin, and pregnancy.
- Mobile-friendly format for effortless client completion prior to arrival.
- Streamline your wellness practice intake workflow in seconds with Doc2Form.
Use cases
Initial client consultations at holistic wellness clinics and day spas.
Pre-treatment screening for mobile massage and aromatherapy practitio…
Pre-treatment screening for mobile massage and aromatherapy practitioners.
Health and safety intake for specialized spa retreats or wellness wor…
Health and safety intake for specialized spa retreats or wellness workshops.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Gender (Dropdown)Select your gender identity.
- Date of Birth (Date)Select your date of birth.
- Email Address (Short answer)We will use this to send appointment confirmations and session notes.
- Phone Number (Short answer)Enter your best contact number.
- Address (Paragraph)Enter your residential address.
- Reason for Visit (Paragraph)Briefly describe what you hope to achieve from your aromatherapy session today (e.g., stress relief, pain management, relaxation).
- Preferred Oils or Scents (Short answer)List any specific essential oils or aromatic profiles you particularly enjoy.
- Non-Preferred Oils or Scents (Short answer)List any scents you dislike or wish to avoid during your treatment.
- Do you have any known allergies? (Checkboxes)Select all that apply or specify below.
- Medical Condition Status (Multiple choice)Do you currently have any active medical conditions we should be aware of?
- Medical Condition Details (Paragraph)If you answered yes above, please describe your medical conditions.
- Are you currently pregnant or breastfeeding? (Multiple choice)Certain essential oils are contraindicated during pregnancy.
- Do you suffer from epilepsy or seizure disorders? (Multiple choice)Some stimulating oils can trigger episodes.
- Do you have high blood pressure (hypertension)? (Multiple choice)Certain oils can affect blood pressure levels.
- Do you have sensitive skin? (Multiple choice)Let us know if your skin reacts easily to topical applications.
- Current Medication List (Paragraph)List any prescription medications or supplements you are currently taking.
- Client Consent & Agreement (Short answer)By typing your full name below, you confirm that the information provided is accurate and that you consent to receiving aromatherapy treatments.
FAQ
What is an aromatherapy client intake form used for?
It helps practitioners gather client health histories, medical conditions, allergies, and scent preferences to ensure treatments are safe and tailored to the individual.
Why is medical screening important in aromatherapy?
Certain essential oils can trigger adverse reactions or conflict with medical conditions such as pregnancy, epilepsy, or hypertension. An intake form helps catch these contraindications beforehand.
Can clients fill out this form on their mobile phones?
Yes! Google Forms are fully responsive and optimized for smartphones, tablets, and computers, allowing clients to complete their paperwork remotely before arriving.
How do I customize the questions on this template?
Once generated in Google Forms, you can easily add, remove, or edit any question to match the specific requirements of your wellness practice.
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.