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Facial Intake Form Template

Streamline Your Client Consultations with Ease

Are you struggling to gather essential information before facial treatments? This facial intake form template is perfect for beauty and health care professionals who want to ensure a smooth client experience. By using this template, you can efficiently collect client details, enhance treatment personalization, improve service quality, and maintain accurate records. Plus, it's designed with WCAG-aligned labels, ensuring accessibility for all your clients. Explore how easy it is to customize and implement!

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Full name
Date of birth
Email address
Mobile phone
Preferred contact method for reminders
Email
Phone call
Text message
No reminders
Emergency contact full name
Emergency contact phone
Gender
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Do you have any medical conditions? Select all that apply.
Please Specify:
Do you have any allergies or sensitivities? Select all that apply.
Please Specify:
Are you pregnant, trying to conceive, or nursing?
Pregnant
Trying to conceive
Nursing
No
Prefer not to say
Are you currently taking any of the following? Select all that apply.
Isotretinoin (Accutane) within the last 12 months
Topical retinoids (e.g., Retin-A, adapalene)
Oral antibiotics
Blood thinners (e.g., warfarin)
Steroids/corticosteroids
Photosensitizing medication (e.g., doxycycline)
Acne topicals with benzoyl peroxide
None
Other
Please Specify:
Please share any medications, conditions, or concerns we should know
Do you currently have sunburn, open cuts, active infection, or feel unwell?
Yes
No
How would you describe your skin type?
Oily
Dry
Combination
Normal
Sensitive
Not sure
What are your top skin concerns today? Select all that apply.
Please Specify:
How often do you experience breakouts?
Never
Rarely
Sometimes
Often
Always
Which products are you currently using regularly? Select all that apply.
Please Specify:
Recent cosmetic procedures or exposures (please select all that apply)
Waxing or threading (past 5 days)
Laser hair removal (past 2 weeks)
Chemical peel (past 2 weeks)
Microneedling (past 2 weeks)
Injectables (Botox/fillers) (past 2 weeks)
Spray tan/self-tanner (past 72 hours)
Tanning bed or sunburn (past 72 hours)
None
Areas to avoid during treatment
Are you comfortable with extractions?
Yes
No
Preferred massage pressure
Light
Medium
Firm
No massage
Fragrance preference
Unscented only
Mild natural essential oils
Fragrance OK
Prefer not to say
I consent to clinical photos for my confidential treatment records
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I consent to use of photos for marketing with identifying features removed where possible
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I agree to receive appointment reminders and updates via SMS/email
Yes
No
Client signature (type full name)
Signature date
I have reviewed the intake information and consent to receive facial treatment today
Strongly disagree
Disagree
Neither
Agree
Strongly agree
{"name":"Full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Full name, Date of birth, Email address","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration representing a facial intake form template for FormCreatorAI article

When to use this form

Use this form before any new skincare client, after a long gap between visits, or when a client changes medications or routines. It captures skin history, allergies, and goals so you can tailor treatments and prevent reactions. Use it for acne programs, anti-aging services, sensitive skin facials, peels, and pre-event treatments. Salons that offer multiple services can pair it with the Hair salon client intake form to keep one record per client. If clients bundle services, schedule their lashes with the Eyelash extension appointment form so timing and contraindications line up. The outcome: safer sessions, better product choices, clear home-care notes, and documented consent that builds trust and protects your business.

Must Ask Facial Intake Questions

  1. What are your top skin concerns and goals?

    This guides your plan and sets expectations for results and aftercare. It also helps you measure progress across visits.

  2. Do you have any allergies, sensitivities, or past reactions to skincare?

    Knowing allergies to ingredients, latex, lidocaine, or fragrance lets you avoid triggers and choose safe alternatives. It reduces risk and supports a calm, comfortable service.

  3. What medications, supplements, and active skincare are you using?

    Medications like isotretinoin, antibiotics, and topicals with retinoids, AHA/BHA, or benzoyl peroxide affect sensitivity and healing. You will adjust exfoliation, extractions, and product strength accordingly.

  4. When was your last exfoliation, peel, waxing, tanning, laser, or sunburn?

    Recent treatments change what you can do today. Timelines help you prevent over-exfoliation and postpone steps if needed.

  5. Are you pregnant, nursing, or managing any medical conditions?

    Certain ingredients and modalities may be unsafe during pregnancy or with specific conditions. If they also plan brow work, align safety across services using the Semi-permanent brows- consultation form .

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