Licensed estheticians and skin therapists
Licensed estheticians verify Accutane clearance timing, current retinoid use, and skin sensitivity level before selecting appropriate peel strength and acids.
Esthetician Client Intake Form Template
Help your estheticians deliver results-driven facials from the very first session. This intake form captures skin type, active concerns, current product use (including active ingredients like retinoids), medical flags, known allergies, and treatment goals — so every treatment is built on facts, not guesswork. Send the link with the appointment confirmation and walk in prepared.
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About this template
An esthetician client intake form is a clinical necessity, not just an administrative courtesy. Many of the most effective facial treatments — chemical peels, microdermabrasion, LED therapy, and high-frequency treatments — have significant contraindications. A client currently on Accutane should never receive a chemical exfoliant. Someone with active cold sores should not receive a lip treatment. A client who just had filler injections needs services routed around the treated area. The intake form is how estheticians know before the session begins.
More about this template
Beyond safety, the form enables personalization at a level clients feel immediately. When an esthetician knows you have combination skin with hyperpigmentation concerns, a history of fragrance sensitivity, and you're already using vitamin C and niacinamide, they can formulate a facial that complements your home routine rather than counteracting it. Clients who feel genuinely understood are the clients who book again.
formformform makes it easy to send this form as part of your booking workflow. Whether you use an online booking system or manual scheduling, you can include the form link in every confirmation message. All responses live in your dashboard, organized by submission date, so you can build a history of each client's evolving skin profile over time.
15 fields to make your own11 required in this starting form
Make it fit your workflow.
Use your own copy to change labels, remove questions and add the details you need. Try the preview alongside this guide to see what respondents will be asked.
The questions, explained
Fields in this template
Review the starting questions and choices. You can change them in your own copy.
Full Name
Cameron Brooks
Email Address
cameron@email.com
Phone Number
(555) 123-4567
Date of Birth
How would you describe your skin type?
6 choices
- Dry
- Normal
- Oily
- Combination (oily T-zone, dry cheeks)
- Sensitive
- Not sure
Current skin concerns (select all that apply):
12 choices
- Acne / Breakouts
- Blackheads / Clogged pores
- Hyperpigmentation / Dark spots
- Redness / Rosacea
- Fine lines and wrinkles
- Dullness / Uneven texture
- Dryness / Dehydration
- Oiliness / Enlarged pores
- Under-eye concerns
- Sagging / Loss of firmness
- Melasma
- None currently
Describe your primary skin concern in your own words
Tell us more about what bothers you most and how long it's been an issue.
How would you describe your current skincare routine?
4 choices
- Minimal (water only or soap)
- Basic (cleanser + moisturizer)
- Intermediate (cleanser, toner, serum, moisturizer, SPF)
- Advanced (multiple actives, regular professional treatments)
Active ingredients you currently use:
8 choices
- Retinol / Retinoids
- AHA (glycolic, lactic acid)
- BHA (salicylic acid)
- Vitamin C
- Niacinamide
- Benzoyl peroxide
- Peptides
- None
Skincare brands or products you currently use
CeraVe, The Ordinary, Tatcha, etc.
Please indicate any of the following that apply:
8 choices
- Taking prescription retinoids (Retin-A, Tretinoin)
- Taking Accutane (isotretinoin)
- Receiving chemotherapy or radiation
- Pregnant or breastfeeding
- Autoimmune skin condition (lupus, psoriasis)
- History of cold sores / herpes simplex
- Recent facial procedure (filler, Botox, laser) — within 2 weeks
- None of the above
Known allergies or sensitivities (select all that apply):
7 choices
- Fragrance
- Dyes / Artificial colorants
- Essential oils
- Nuts / Nut-derived ingredients
- Latex
- Specific acids (please note below)
- No known allergies
Allergy notes or specific ingredients to avoid
e.g., allergic to tea tree oil, sensitive to mandelic acid
What are your goals for today's treatment?
8 choices
- Deep cleanse and exfoliation
- Reduce breakouts and congestion
- Brighten and even skin tone
- Reduce fine lines and signs of aging
- Hydrate and restore moisture barrier
- Calm inflammation and sensitivity
- Relaxation and self-care
- Ongoing maintenance
Any additional notes or questions for your esthetician?
Anything else relevant to your skin or your visit today.
Where it fits
Who uses this template
Suggested uses, and why this starting point can help. Adapt the questions to your own process.
Medical estheticians and med spas
Advanced estheticians or medical providers collect keloid history, active skin infections, current blood-thinning medications, and post-treatment downtime availability before collagen induction therapy.
Day spas and resort spas
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Current skin concerns (select all that apply):” in particular and adapt it to the detail you need.
Acne clinics and skincare specialists
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Describe your primary skin concern in your own words” in particular and adapt it to the detail you need.
Anti-aging and skin rejuvenation studios
Skin rejuvenation estheticians document fine line concerns, sun damage history, collagen stimulation treatment interest, and comfort level with downtime for advanced treatments.
Freelance mobile estheticians
Get a useful brief before the first conversation. Written context helps you assess fit, prepare questions and decide what to discuss next. Review “Active ingredients you currently use:” in particular and adapt it to the detail you need.
Beauty schools offering student clinic facials
Cosmetology schools collect informed consent for student-performed services, client skin details, and instructor supervision acknowledgment before student facial appointments.
What's included
Skin type radio button (including 'not sure' for new-to-skincare clients)
Comprehensive skin concern checklist (12 conditions)
Current routine complexity and active ingredient inventory
Medical contraindication checklist (Accutane, retinoids, recent injectables)
Allergy and sensitivity checklist with open notes field
Treatment goals checklist to align session focus
Confidential — only your team can view submissions
Sends instant email notification on every new submission
How to create an esthetician client intake form
- 1
Click 'Use this template' to open the Esthetician Client Intake Form in formformform.
- 2
Customize the active ingredients checklist to reflect the products you commonly encounter and the treatments you offer.
- 3
Add any treatment-specific contraindications required by your licensing board or insurance policy.
- 4
Update the treatment goals checklist to match your service menu.
- 5
Include the form link in your appointment confirmation messages, asking clients to complete it at least 24 hours before their visit.
- 6
Review completed forms before each client's appointment to plan the appropriate treatment and product selection.
Best practices for your esthetician client intake form
Ask about active ingredients specifically
a client on tretinoin who didn't tell you may react badly to your glycolic acid peel. This question protects both of you.
Make the Accutane and retinoid fields required
these are the two most common contraindications estheticians miss. A client who answers 'Accutane' is a complete no for most exfoliating treatments.
Include 'recent injectables' in the medical checklist
Botox and filler clients should not receive facial massage or intense heat treatments in the injected areas for at least two weeks.
Ask about cold sore history
HSV-1 can be triggered by microdermabrasion, laser, and chemical peels. Knowing this in advance allows you to have an antiviral protocol ready.
Re-intake returning clients annually
product routines change, new medications are started, and skin conditions evolve. An annual re-intake keeps your records accurate.
Use the current routine section to identify over-exfoliation
clients using multiple actives at home may already have a compromised barrier. The intake form reveals this before you add another layer of exfoliation.
15 form ideas you can build with this template
Acne Facial Consultation Form
Acne specialists collect breakout frequency, current prescription topicals, diet-related triggers, and hormonal cycle patterns to build a targeted clear-skin treatment plan.
Anti-Aging Facial Intake Form
Skin rejuvenation estheticians document fine line concerns, sun damage history, collagen stimulation treatment interest, and comfort level with downtime for advanced treatments.
Chemical Peel Pre-Treatment Screening Form
Licensed estheticians verify Accutane clearance timing, current retinoid use, and skin sensitivity level before selecting appropriate peel strength and acids.
Microdermabrasion Intake Form
Skin therapists screen for active rosacea, redness, and capillary fragility before performing physical resurfacing to avoid worsening inflammation or broken capillaries.
LED Light Therapy Consultation Form
Photobiomodulation practitioners screen for photosensitive medications, recent laser history, and target skin concern (acne vs. anti-aging vs. redness) before light therapy sessions.
HydraFacial Pre-Treatment Intake
Medical spas collect existing product actives, skin sensitivity, and specific congestion or tone concerns before customizing HydraFacial serum boosters.
Teen Acne Facial Intake Form
Estheticians working with teenage clients gather parent-provided information on current medications, prescription history, and dietary habits alongside the client's own skin concern description.
Bridal Pre-Wedding Facial Program Form
Estheticians starting a bridal skin prep program collect wedding date, current skin baseline, treatment frequency availability, and product sensitivity for a multi-session plan.
Brow and Lash Tinting Client Form
Brow specialists collect patch test history, allergy to dyes, existing brow shape preferences, and natural hair color for tinting service safety and color selection.
Dermaplaning Consultation and Consent
Estheticians verify the absence of active acne, keratosis pilaris, and excessive facial hair growth that would contraindicate dermaplaning before booking a session.
Microneedling Pre-Treatment Screening Form
Advanced estheticians or medical providers collect keloid history, active skin infections, current blood-thinning medications, and post-treatment downtime availability before collagen induction therapy.
Skin of Color Specialist Intake Form
Estheticians specializing in melanin-rich skin collect hyperpigmentation history, post-inflammatory response tendency, and product sensitivities to safely select appropriate treatments.
Rosacea-Focused Skin Consultation
Skin therapists working with rosacea clients gather known triggers, current flare status, prescribed topicals, and experience with previous professional treatments before a calming facial.
Beauty School Clinic Client Consent Form
Cosmetology schools collect informed consent for student-performed services, client skin details, and instructor supervision acknowledgment before student facial appointments.
Medical Esthetics Post-Procedure Skin Form
Med spas collect recovery phase details, swelling or bruising status, and skin barrier condition after laser or injectable procedures to plan safe complementary facial services.
Frequently asked questions
Why do you need to know what skincare products I currently use?
Active ingredients like retinoids, AHAs, and BHAs significantly affect how your skin responds to professional treatments. Knowing what you use at home helps your esthetician choose treatments that work with your routine — not against it — and avoids over-exfoliation or adverse reactions.
Can this form be used for body treatments, not just facials?
This form is focused on facial skin consultation. For full-body treatments, you'd want to add body-specific questions about the treatment area and adjust the skin concern checklist. The health and allergy sections transfer directly to body treatment intake as well.
Do I need to update my intake form for every visit?
Not necessarily every visit, but at least annually or whenever something significant changes — a new medication, a recent procedure, or a new skin concern. Many practices update client intake forms once per year.
Can I add a photo upload field so clients can share current skin photos?
Yes. Adding a file upload field lets clients attach bare-faced photos taken in natural light, which can help estheticians assess skin tone, texture, and hyperpigmentation before the consultation begins.
Is this form appropriate for minors receiving facials?
You should add a parent/guardian consent section for clients under 18, and note that a parent or guardian must be present for the appointment. Many states also require parental consent for facial treatments on minors.
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