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Skin Care Assessment Form Template

Streamline Your Skin Care Consultation Process

Are you struggling to gather essential skin information from your clients? This Skin Care Assessment Form template is designed to help estheticians, dermatologists, and beauty professionals effectively evaluate their clients' skin needs. By using this template, you can enhance client consultations, streamline treatment planning, and improve overall service quality, ensuring that your clients receive personalized skincare recommendations. Plus, it features WCAG-aligned labels for a seamless user experience. Start creating your customized form to enhance your practice today.

Full name
Email address
What is your age group?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
How would you describe your skin type?
Very dry
Dry
Combination
Normal
Oily
Very oily
Unsure
How sensitive is your skin?
Not sensitive
Slightly sensitive
Moderately sensitive
Very sensitive
Unsure
What is your Fitzpatrick skin type?
I (Very fair, always burns)
II (Fair, usually burns)
III (Medium, sometimes mild burn)
IV (Olive, rarely burns)
V (Brown, very rarely burns)
VI (Dark brown/black, never burns)
Unsure
What are your current skin concerns?
Please Specify:
Which is your top priority to improve first?
How satisfied are you with your current skin?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
How often do you cleanse your face?
Never
Once daily
Twice daily
More than twice daily
Only after workouts
Not sure
Which products are you currently using?
Do you use sunscreen (SPF 30+) daily?
Yes
No
Have you been diagnosed with any skin conditions?
Please Specify:
Do you have any allergies or ingredient sensitivities?
Please Specify:
Are you currently pregnant or breastfeeding?
Yes
No
Not applicable
Prefer not to say
Are you taking any medications or undergoing treatments that may affect your skin?
Please Specify:
How often do you feel stressed?
Very rarely
Rarely
Sometimes
Often
Very often
Do you have any product or ingredient preferences to avoid?
What is your approximate monthly skincare budget?
$0-$50
$51-$100
$101-$200
$201-$400
$401+
Prefer not to say
May we contact you with personalized skincare recommendations?
Yes
No
Type your name as signature
Date
I consent to my information being stored and processed for assessment purposes.
Yes
No
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Paper art illustration showcasing a skin care assessment form template for FormCreatorAI article

When to use this form

Use this assessment before any new facial, peel, or treatment plan. It helps you learn skin type, triggers, and goals so you deliver safe, targeted care. Spas can pair it with the Spa client intake form to capture services and preferences in one flow. Independent consultants can reference the Mary kay beauty profile by julie potts form when tailoring product recs and makeup matches. It also supports pre-service risk checks for clients with allergies, medications, or pregnancy. Whether you run a busy clinic or a mobile practice, you get clear notes, baseline photos, and follow-up actions, so each visit builds on the last.

Must Ask Skin Care Assessment Questions

  1. What are your top skin goals for the next 3 months?

    This sets expectations and helps you prioritize treatments and home care. With a clear goal, you can measure progress and adjust faster.

  2. How would you describe your skin type and current concerns (oiliness, dryness, acne, sensitivity, hyperpigmentation)?

    Accurate input guides ingredient choices and service timing. It reduces trial-and-error and limits irritation or breakouts.

  3. Do you have any allergies or past reactions to skin care, makeup, fragrance, or adhesives?

    This protects clients from contact dermatitis and adverse events. For lash or brow services, review the Eyelash extension consent form to confirm safe products and patch tests.

  4. What products and actives are you using now, and how often (retinoids, AHAs/BHAs, vitamin C, benzoyl peroxide)?

    Knowing actives prevents over-exfoliation and ingredient conflicts. You can stagger usage and pick protocols that support the skin barrier.

  5. Are you pregnant, nursing, taking medications (like isotretinoin), or under care for a skin condition?

    These factors change what is safe, from peels to essential oils. Document them alongside the Client intake consent form to align care and legal requirements.

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