About this template
A facial client intake and consent form is an essential tool for estheticians, spas, and skincare clinics to evaluate a client's skin health, medical background, and current skincare routine before administering treatments. This comprehensive questionnaire helps professionals identify potential contraindications, skin sensitivities, and specific aesthetic goals to ensure safe and effective service delivery.
This Doc2Form template replaces messy paper clipboards with a clean digital questionnaire that clients can complete on their phones before arriving. It captures essential personal details, medical history, current medications, lifestyle factors, previous treatments, and formal informed consent. By gathering this data upfront, skincare professionals can customize treatments, avoid adverse reactions, and maintain accurate client records.
Key features
- Collect detailed skin history and medical backgrounds before appointments.
- Identify potential contraindications like allergies, recent surgeries, or active prescriptions.
- Document client skincare goals and daily product regimens.
- Secure digital informed consent for specialized facial treatments.
- Easily accessible on any mobile device or desktop browser.
Use cases
- New client onboarding at day spas and medical aesthetics clinics.
- Pre-treatment skin assessments for chemical peels and advanced facials.
- Documenting signed liability waivers and treatment acknowledgments.
What this form collects
- Today's Date (Date)Enter today's date.
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Enter your date of birth.
- Email Address (Short answer)Enter your primary email for appointment confirmations and skincare tips.
- Phone Number (Short answer)Enter your mobile phone number.
- Emergency Contact Name and Phone (Short answer)Provide the name and phone number of someone we can contact in case of an emergency.
- Are you currently under the care of a dermatologist or physician for your skin? (Multiple choice)Select your current medical care status.
- Medical Conditions (Checkboxes)Check any conditions that apply to you currently or in the past.
- Known Allergies and Sensitivities (Paragraph)List any allergies to ingredients, fragrances, nuts, latex, or aspirin.
- Current Medications and Topical Products (Paragraph)List any prescription medications, retinoids, AHAs/BHAs, or acne treatments you currently use.
- Are you pregnant or breastfeeding? (Multiple choice)Certain treatments and ingredients are restricted during pregnancy.
- Have you had Botox, fillers, or other injectables in the last 4 weeks? (Multiple choice)Select yes if you have had facial injectables recently.
- Skin Type (Dropdown)Select the option that best describes your overall skin type.
- Primary Skin Concerns (Checkboxes)Select your main skin goals or issues you would like to address.
- Daily Sunscreen Use (Multiple choice)How often do you apply SPF during the day?
- Client Consent and Acknowledgment (Short answer)By typing your full name below, you confirm that the information provided is accurate and that you grant permission for aesthetic services to be performed.
FAQ
Why is a client intake form necessary for facials?
It ensures the esthetician is aware of any medical conditions, allergies, or medications (such as retinoids or acne treatments) that could react negatively with facial products or procedures.
Can I customize the questions in this template?
Yes! Once you convert this template to Google Forms, you can fully edit, add, or remove any questions to fit your specific spa menu and policies.
How do clients sign the consent section?
You can include a text field for clients to type their full legal name and date as an electronic acknowledgement, or use a dedicated signature collection workflow.
Is this form mobile-friendly?
Google Forms automatically optimizes all questionnaires for smartphones and tablets, allowing clients to fill out their intake forms easily before walking through your door.
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.