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Esthetician Consent Form Template

Streamline Client Agreements with This Essential Form

Gathering client consent can be a stressful part of running your esthetician business. This esthetician consent form template helps your salon establish clear agreements and protect both you and your clients. With this customizable form, you can ensure that clients are informed about treatments, minimize liability, and promote trust, enhancing client relationships and satisfaction. Easily adapt it to fit your specific services and maintain compliance with industry standards. Try out the live template to see how it can simplify your process.

Use this Template (FREE) Live Preview
Full name
Date of birth
Email address
Mobile phone number
Emergency contact full name
Emergency contact phone
Preferred contact method
Text message
Phone call
Email
No preference
Are you currently under a physician's care for any condition?
Yes
No
Please select any conditions that apply to you
Please Specify:
Do you have any allergies or sensitivities?
Please Specify:
Are you pregnant or breastfeeding?
Pregnant
Breastfeeding
No
Prefer not to say
Do you have a history of cold sores (herpes simplex)?
Yes
No
What are your current skin concerns? (select all that apply)
Please Specify:
Have you taken Accutane (isotretinoin) in the past 12 months?
Yes
No
Are you currently using any of the following products or medications?
Please Specify:
List current medications and supplements (names and doses if known)
In the past 2 weeks, have you had any of the following?
Do you currently have any open wounds, cuts, or active infections on the treatment area?
Yes
No
Which services are you seeking today?
Please Specify:
Areas to be treated
Please Specify:
Appointment date
Have you completed a patch test with us in the last 12 months (if applicable)?
Yes
No
Not applicable
Do you consent to before/after photos for your confidential client chart?
Yes
No
Do you consent to the use of photos for marketing (website/social), with identifying features minimized or removed?
Yes
No
May we send appointment reminders and aftercare by SMS or email?
Yes
No
I have provided accurate and complete health information and will inform my provider of any changes.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand that esthetic treatments may involve risks such as redness, irritation, allergic reaction, hyperpigmentation, or infection.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand results vary and no specific outcome is guaranteed.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I acknowledge the cancellation and no-show policy of this practice.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Client signature (type your full name)
Signature date
I consent to receive the selected non-medical esthetic treatment(s) today.
Yes
No
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Artistic paper illustration featuring a consent form relevant to esthetician services and guidance

When to use this form

Use this form before any skin service where you touch the face or apply active products. It is essential for first-time clients, new services, or when health or medications change. Have clients review and sign before facials, peels, microdermabrasion, waxing, dermaplaning, or brow work. It helps you screen for allergies, choose products safely, and document informed consent. Pair it with the Client intake consent form to capture full history for new clients. If you offer lash services, use the Lash lift & tint consent form for that procedure. The result: fewer reactions, clearer expectations, and cleaner records that protect your business and your clients.

Must Ask Esthetician Consent Questions

  1. Do you have any allergies or sensitivities to skincare ingredients, adhesives, or latex?

    Allergy details help you avoid triggers and choose safe products or a patch test. This reduces the risk of hives, swelling, or contact dermatitis during and after the service.

  2. What medications, supplements, or topical products are you using (for example, retinoids, isotretinoin, antibiotics, AHAs/BHAs)?

    Certain drugs and actives thin skin or increase sensitivity, which changes how you prep and treat. Documenting them guides timing, strength, and whether to reschedule for safety.

  3. What skin treatments have you had in the last 24 weeks (peels, microdermabrasion, injectables, laser), and how did your skin react?

    Recent procedures affect barrier health and healing time. Knowing reactions helps you prevent over-exfoliation, pigment issues, or irritation from stacked services.

  4. Are you pregnant, nursing, or managing any medical conditions (such as diabetes or autoimmune disorders) that may affect treatment?

    Some ingredients and modalities are not suitable during pregnancy or with certain conditions. This question keeps your plan within safe, approved options.

  5. Do you consent to today's treatment, understand potential risks and sensations, and agree to follow aftercare instructions?

    Written consent clarifies expectations and protects both you and the client if concerns arise. If the visit also includes bodywork, use a separate Massage therapy consent form to keep records accurate and compliant.

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