Disclaimer
The information provided here serves as a general example for client intake procedures in beauty and skincare services. It is not legal advice and should not replace consultation with a licensed professional familiar with local regulations and practices. Laws and standards may differ by location, requiring adjustments to ensure compliance. Use of this example is at your own discretion, and we assume no liability for errors, omissions, or issues arising from its use without proper professional guidance.
This is a sample esthetician intake form template. Please adjust details as needed to suit your specific practice and client.
Esthetician Intake Form Template
Client Information:
Client Name: ________________________________
Date of Birth: ______________________________
Contact Number: ____________________________
Email Address: _____________________________
Skin History and Concerns:
Please describe your current skin concerns, allergies, sensitivities, or any treatments you’ve previously received:
______________________________________________________________________________
Medical History:
Please list any relevant medical conditions, medications, or skin-related allergies:
______________________________________________________________________________
Previous Treatments & Products Used:
Describe any prior skin treatments or products currently being used:
______________________________________________________________________________
Consent & Agreement:
I confirm that the above information is accurate and understand that my skin treatment will be based on this information. I consent to the esthetician performing the suggested treatments and understand that results may vary.
Signature: ________________________________
Date: ____________________________________
Additional Notes or Special Instructions:
______________________________________________________________________________