About this template
An Esthetician Client Intake Form is an essential document used by skincare professionals, medical spas, and salons to capture detailed information about a client's health history, current skincare routine, and specific aesthetic goals. Before administering facials, chemical peels, or other specialized skin treatments, estheticians must understand potential contraindications such as allergies, pregnancy, current medications, or recent surgeries to ensure client safety and optimal treatment outcomes.
This comprehensive intake questionnaire covers everything from basic contact details to medical conditions, skin healing responses, and lifestyle factors like caffeine and alcohol consumption. It also screens for device use, such as contact lenses or implanted metals, which may impact specific treatments. By gathering this data upfront via Doc2Form, clinics eliminate clipboard clutter, maintain organized digital records in Google Drive, and provide a polished, professional onboarding experience for every new client.
Key features
- Collect complete medical history and allergy alerts prior to appointments.
- Screen for contraindications like pregnancy, medications, and recent surgeries.
- Understand current at-home skincare routines and product usage.
- Streamline client onboarding with a mobile-friendly digital format.
- Automatically store responses in Google Sheets for easy clinic tracking.
Use cases
- New client onboarding at medical spas and day salons.
- Pre-treatment consultations for chemical peels and advanced facials.
- Tracking skin concerns and product allergies for personalized regimens.
- Digital liability and consent documentation for aesthetic procedures.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Select your birth date.
- Gender (Dropdown)Choose how you identify.
- Phone Number (Short answer)Enter the best number to reach you for appointment reminders.
- Email Address (Short answer)Where should we send your booking confirmations and aftercare tips?
- Home Address (Paragraph)Enter your street address, city, state, and zip code.
- Occupation (Short answer)Let us know what you do for work (helps us understand lifestyle skin exposure).
- Medical Conditions (Checkboxes)Select any conditions that apply to you currently or in the past.
- Primary Skin Concerns (Paragraph)What are your main goals or issues you would like to address today?
- Skin Healing Response (Multiple choice)How does your skin typically react after a cut, scrape, or blemish?
- At-Home Skincare Routine (Paragraph)Briefly describe the products you use daily (cleanser, moisturizer, SPF, retinoids, etc.).
- Are you currently pregnant or breastfeeding? (Multiple choice)Certain active ingredients (like high-strength retinoids or salicylic acid) must be avoided during pregnancy.
- Current Medications & Skincare Products (Paragraph)List any prescription medications, oral acne medications (e.g., Accutane), or topical retinoids you have used in the last 6 months.
- Recent Surgeries or Cosmetic Procedures (Paragraph)Have you had any facial surgeries, laser treatments, chemical peels, or botox/fillers in the last 3 months?
- Do you wear contact lenses? (Multiple choice)Important for eye treatments and lash services.
- Terms and Conditions (Multiple choice)Please confirm that the information provided above is accurate to the best of your knowledge and that you consent to treatment.
- Client Signature (Short answer)Please paste a link to your signed digital agreement or type your full legal name as an electronic signature.
- Date Signed (Date)Select today's date.
FAQ
Why is an esthetician client intake form necessary?
It helps estheticians identify potential health risks, skin sensitivities, and contraindications before starting any cosmetic or skin treatment, ensuring client safety and customized care.
What key information should be included in a skincare intake form?
A thorough form should collect client contact information, medical history, current medications, existing skincare products, lifestyle habits, and informed consent.
Can I customize this template to add specific treatments my spa offers?
Yes! Once generated in Google Forms, you can easily add, remove, or edit questions to match your exact service menu and clinic policies.
How do clients complete this form before their appointment?
You can send clients a direct link to the Google Form via email or text confirmation message so they can fill it out conveniently from their phone or computer before arriving.
Where are the submitted client intake responses stored?
All client responses are automatically saved in your connected Google Sheet, giving you a secure, searchable database of your salon's client health histories.
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.