About this template
A dermaplaning consultation form is an essential tool for estheticians, dermatologists, and medical spa professionals. Before performing a physical exfoliation and vellus hair removal procedure, practitioners must screen clients for active skin conditions, chemical peel history, retinoid use, and known allergies to prevent adverse reactions and ensure optimal treatment results.
This comprehensive consultation template captures critical client background data, emergency contact details, and informed consent acknowledgements. By gathering skin sensitivities, recent sun exposure, and treatment expectations upfront, practitioners can customize the procedure safely while securing legally sound consent.
Doc2Form makes it easy to distribute this consultation template directly to your clients via a simple link or QR code at your front desk, allowing them to complete their medical history securely on any smartphone or tablet before their appointment begins.
Key features
- Screen clients for active acne, rosacea, and chemical peel history
- Collect mandatory pre-treatment acknowledgements and liability waivers
- Gather emergency contact details and skin sensitivity profiles
- Streamline client intake digitally before appointments begin
Use cases
- New client onboarding at medical spas and dermatology clinics
- Pre-treatment screening for facial exfoliation procedures
- Informed consent and policy agreement tracking for estheticians
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Phone Number (Short answer)Enter your primary mobile number for appointment reminders.
- Emergency Contact Full Name (Short answer)Name of a person we can reach in case of an emergency.
- Have you had dermaplaning performed before? (Multiple choice)Select your prior experience with this treatment.
- Date of Last Dermaplaning Treatment (Date)If applicable, enter approximately when you last had this procedure done.
- Recent Skin Treatments or Sun Exposure (Multiple choice)Have you had a chemical peel, microdermabrasion, or intentional tanning in the last 14 days?
- Skin Type (Dropdown)Choose the category that best describes your daily skin behavior.
- Do you currently have a facial sunburn? (Multiple choice)Active sunburns prevent us from performing exfoliation procedures.
- Do you have any known skin allergies or sensitivities? (Multiple choice)Include reactions to topical products, latex, nickel, or numbing agents.
- Allergy Details (Paragraph)If you answered yes above, please list your allergies and specific reactions.
- Side Effects Acknowledgement (Multiple choice)I understand that temporary redness, slight windburn sensation, or minor irritation can occasionally occur post-treatment.
- Vellus Hair Removal Acknowledgement (Multiple choice)I understand that dermaplaning removes vellus hair (peach fuzz) and that hair will grow back at its normal rate and texture, not thicker or darker.
- Results May Vary Acknowledgement (Multiple choice)I understand that individual skin results vary and multiple sessions may be required to achieve my aesthetic goals.
- Sun Exposure & Sunscreen Acknowledgement (Multiple choice)I agree to avoid direct unprotected sun exposure and wear SPF 30+ daily following my dermaplaning procedure.
- Recent Injections or Retin-A Use (Multiple choice)I confirm I have disclosed any recent facial fillers, botox, or prescription retinoids used within the prescribed withholding window.
- Post-Treatment Exercise Acknowledgement (Multiple choice)I understand I should avoid heavy sweating, saunas, and intense workouts for 24 hours post-treatment.
- Treatment Agreement Acknowledgement (Multiple choice)I release the practitioner and facility from liability for conditions not disclosed on this form.
- Client Electronic Signature (Short answer)Type your full legal name to serve as your electronic signature.
- Signature Date (Date)Today's date.
- Parent or Guardian Signature (If Under 18) (Short answer)If the client is a minor, parent or guardian must type their full name here.
- Parent or Guardian Signature Date (Date)Date of guardian signature, if applicable.
FAQ
How can clients fill out this consultation form?
You can share the Google Form link via email or text prior to their appointment, or have clients complete it on a tablet in your waiting room.
Can I customize the questions on this template?
Yes. Once you load the template into your Google Drive, you can fully edit, add, or remove questions to match your practice's specific protocol.
Why is a dermaplaning consultation necessary?
It helps identify contraindications such as active sunburns, recent chemical peels, or blood-thinning medications that could compromise the safety of the exfoliation.
How do I collect client signatures using Google Forms?
You can include a dedicated text field for clients to type their legal name as an electronic signature or use the signature date field to confirm acknowledgement.
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.