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Skin Care Consultation Form Template

Streamline Your Client Consultations with Ease

Are you finding it challenging to gather detailed skin and health information from clients? This Skin Care Consultation Form Template is designed for estheticians and skincare professionals like you, helping you collect essential data while enhancing the client experience. Capture contact details, skincare concerns, and medical history seamlessly, improve treatment planning, foster trust with personalized consultations, and boost client retention. Explore how this efficient form can elevate your skincare consultations.

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Full name
Email address
Phone number
Preferred contact method
Email
Phone call
Text message
Any
Age range
Under 18
18-24
25-34
35-44
45-54
55-64
65+
If you selected 'Prefer to self-describe', please specify
Gender identity
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Primary skin type
Normal
Dry
Oily
Combination
Sensitive
Not sure
Fitzpatrick skin phototype
I - Very fair, always burns, never tans
II - Fair, usually burns, tans minimally
III - Medium, sometimes mild burn, tans uniformly
IV - Olive, rarely burns, tans easily
V - Brown, very rarely burns, tans very easily
VI - Deeply pigmented, never burns
Not sure
How sensitive is your skin?
Very low
Low
Moderate
High
Very high
Not sure
What are your current skin concerns?
Please Specify:
What are your skincare goals?
Do you have any allergies or sensitivities?
Please Specify:
Have you been diagnosed with any of the following?
Eczema
Psoriasis
Dermatitis
Rosacea
Cold sores/herpes simplex
Keloid scarring tendency
None
Other
Please Specify:
Are you currently under the care of a dermatologist or physician for your skin?
Yes
No
Current medications or supplements that may affect your skin
Isotretinoin (past 12 months)
Topical retinoids (tretinoin/adapalene)
Antibiotics
Hormonal therapy or contraceptives
Steroids/corticosteroids
Blood thinners
Photosensitizing meds (e.g., doxycycline)
None
Other
Please Specify:
Are you currently pregnant, breastfeeding, or planning pregnancy?
Pregnant
Breastfeeding
Planning pregnancy
None of the above
Prefer not to say
Do you tend to develop dark marks or raised scars after skin injury?
Yes
No
Not sure
When was your most recent sunburn?
Within the past 2 weeks
2-4 weeks ago
1-3 months ago
More than 3 months ago
I do not remember
How often do you apply SPF 30+ on your face daily?
Never
Rarely
Sometimes
Often
Always
Do you currently smoke or vape?
Yes
No
Recent cosmetic procedures
Chemical peel within the past 2 weeks
Microneedling within the past 2 weeks
Laser/IPL within the past 2 weeks
Botox/fillers within the past 2 weeks
Waxing/threading within the past 7 days
None
Other
Please Specify:
How often do you cleanse your face?
Never
Once daily
Twice daily
More than twice daily
Which products are you currently using?
Please Specify:
Products or ingredients your skin reacts poorly to
Have you experienced a reaction to a skincare treatment in the past?
Yes
No
Not sure
Which areas would you like to treat?
Face
Neck
Chest
Back
Hands
Other
Please Specify:
Preferred appointment days
Weekday mornings
Weekday afternoons
Weekday evenings
Weekends
Any
Best time to contact you
Morning (8am-12pm)
Afternoon (12-3pm)
Late afternoon (3-6pm)
Evening (after 6pm)
Any
How did you hear about us?
Friend or family
Social media
Google/online search
Walk-in/passing by
Event
Referral from another provider
Other
Please Specify:
I confirm the information provided is accurate to the best of my knowledge.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand that skincare treatments may carry risks and I agree to follow aftercare instructions.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I consent to before-and-after photos being taken for treatment tracking.
Yes
No
Type your full name as your signature
Date
I would like to receive skincare tips and offers by email or text.
Yes
No
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Paper art illustration depicting a skin care consultation form for a Skin Care Consultation Form Template article

When to use this form

Use this form whenever you onboard a new facial client, assess a breakout flare-up, or plan a peel or microderm appointment. It captures skin type, concerns, product history, medications, and sensitivities so you can select safe treatments and set expectations. Spas pair it with a Facial intake form to speed check-in and keep records consistent. For services that require written permission, add a Spa consent form to cover risks and aftercare. Mobile or online, it helps solo estheticians and clinics deliver personalized advice and avoid reactions. The result: a clear plan, fewer surprises, and happier clients.

Must Ask Skin Care Consultation Questions

  1. What are your top skin concerns and goals?

    This focuses the consult on what matters most to you and sets measurable outcomes for the visit. If routine planning is the next step, continue with a Customized skincare routine form to translate goals into daily care.

  2. Do you have any allergies, ingredient sensitivities, or past reactions to products or treatments?

    Your history helps prevent reactions and guides patch testing. It also flags ingredients to avoid during services and in home care.

  3. What is your current skincare routine, including product names, actives, and frequency?

    Knowing products, actives, and frequency prevents conflicts, like layering strong exfoliants with retinoids. It also shows where to simplify or upgrade for better results.

  4. What medical conditions, medications, or recent procedures should we know about (including pregnancy or nursing)?

    Certain meds and conditions change skin tolerance and healing time. Sharing this helps us adjust techniques, intensity, and aftercare safely.

  5. When was your last hair removal, exfoliation, or significant sun exposure, and do you wear daily SPF?

    Recent waxing, peels, or sun can increase sensitivity and risk of hyperpigmentation. For hair removal services, a Waxing consent form confirms timing, risks, and aftercare.

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