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Customized Skincare Routine Form Template

Create tailored skincare solutions that fit your clients' unique needs

Struggling to offer individualized skincare advice? This customized skincare routine form template enables you to gather essential information from your clients, ensuring you recommend the perfect regimen for their skin. With this easy-to-use template, you can create detailed skincare assessments, track clients' progress, and enhance customer satisfaction, all while adhering to best practices for accessibility. Experience the benefits of tailored skincare services-with just a few clicks, you can start crafting personalized plans right now!

Use this Template (FREE) Live Preview
Full name
Email address
Which age group are you in?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
What are your top skin goals? Select all that apply.
Please Specify:
How would you describe your skin type?
Oily
Dry
Combination
Normal
Not sure
Which best matches your natural skin tone (Fitzpatrick type)?
I Very fair, always burns, never tans
II Fair, usually burns, tans minimally
III Medium, sometimes burns, gradually tans
IV Olive, rarely burns, tans easily
V Brown, very rarely burns, tans very easily
VI Deeply pigmented, never burns, tans deeply
Not sure
How often do you get facial breakouts?
Never
Rarely
Sometimes
Often
Always
How sensitive is your skin?
Not sensitive
Slightly sensitive
Moderately sensitive
Very sensitive
Not sure
Do you have any diagnosed skin conditions?
Acne
Rosacea
Eczema (atopic dermatitis)
Psoriasis
Melasma or post-inflammatory hyperpigmentation
Keratosis pilaris
None
Other
Please Specify:
Any known allergies or ingredient sensitivities? Select all that apply.
Please Specify:
Are you currently pregnant or breastfeeding?
Yes
No
Prefer not to say
Which skincare steps do you use regularly? Select all that apply.
Please Specify:
How often do you exfoliate your face?
Never
Less than once a week
1-2 times per week
3-4 times per week
Daily
Not sure
Which active ingredients are you currently using? Select all that apply.
Please Specify:
How often do you apply sunscreen to your face?
Never
Rarely
Sometimes
Often
Always
Are you currently using or have you used isotretinoin (Accutane) in the last 12 months?
Yes
No
Not sure
What is your primary climate?
Humid/tropical
Dry/arid
Temperate
Cold
Varies/seasonal
Which of these apply to your routine or environment? Select all that apply.
Mostly indoors (climate-controlled)
Regular outdoor sun exposure
High pollution/urban environment
Frequent air travel
Gym/sweat regularly
Wear facial covering (mask) often
None of the above
How complex would you like your routine to be?
Minimal (1-2 steps per routine)
Moderate (3-4 steps per routine)
Comprehensive (5+ steps per routine)
No preference
What is your monthly budget for skincare products?
Under $50
$50-$100
$100-$200
Over $200
No preference
Which product attributes matter to you? Select all that apply.
Anything else you would like us to know?
May we contact you with your customized routine and tips?
Yes
No
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Paper art illustration depicting a skincare routine form layout with various skincare product icons and fields for customization.

When to use this form

Use this when you need to build a personalized regimen for clients or customers. It is great for estheticians, spas, beauty consultants, and skincare brands. Use it before a facial, after an online consultation, or to follow up after a breakout or treatment. The form gathers skin type, concerns, sensitivities, current routine, and goals to map AM/PM steps and product plans. Pair it with the Skin care assessment form to capture baseline skin details, and with the Spa client intake form to record contact info, history, and contraindications. For beauty reps, the Mary kay beauty profile by julie potts form can complement this skin care template when matching sets and shades. Outcome: a clear, safe plan your client will actually follow.

Must Ask Customized Skincare Routine Questions

  1. What are your top skin concerns and your skin type?

    This grounds your recommendations in what matters most and how their skin behaves. You prioritize the right textures and actives, leading to faster, clearer results.

  2. Do you have any allergies, sensitivities, or ingredients to avoid?

    Recording this prevents irritation and adverse reactions. You can document restrictions in a Spa consent form to reduce risk and build trust.

  3. What products are you currently using, and how does your skin respond?

    This helps you avoid conflicts like double exfoliation and keeps what already works. You can phase changes step by step to minimize purging and confusion.

  4. What is your budget and how much time can you commit daily?

    A routine that fits your clients wallet and schedule is far more likely to stick. You choose formats (multi-use, bundles) and cadence that they can maintain.

  5. Are you on any medications or receiving treatments (e.g., retinoids, peels, lasers)?

    This flags contraindications and timing issues so you keep skin safe. You can adjust actives, space treatments, and emphasize SPF and barrier repair.

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