Esthetician intake form template

Generate a professional esthetician client intake form in seconds with AI. Covers skin type, contraindications, allergies, and consent. Free, shareable by link.

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Who is this esthetician intake form for?

Esthetician client intake forms are built for licensed skincare professionals who need to collect comprehensive health information before providing facial treatments. This template is perfect for solo estheticians, med spa owners, beauty studio operators, and esthetics students setting up their practice. The form captures essential details like skin type assessment, current skincare routine, known allergies and sensitivities, contraindications such as Accutane or retinoid use, medical history, and treatment consent. It's designed specifically for facial services, chemical peels, and general skincare treatments where client safety depends on thorough pre-treatment screening. Weavely's AI-powered form includes all the professional fields estheticians need without the hassle of building from scratch. You can instantly customize the questions, match your brand colors and fonts, and share via link or print for paper backup. No coding required — just describe your specific needs and start collecting client information in minutes.

<div class="fields-overview"> <h2>What's included in this esthetician client intake form template</h2> <div class="fo-card"> <h3>Client Contact and Emergency Information</h3> <p class="card-desc">Capture essential contact details and emergency contact information for client safety and communication.</p> <div class="field-list"> <div class="field-item"> <span class="field-label">Full Name</span> <span class="field-badge badge-basic"> <i class="fal fa-font"></i> Short Text </span> </div> <div class="field-item"> <span class="field-label">Email Address</span> <span class="field-badge badge-basic"> <i class="fal fa-envelope"></i> Email </span> </div> <div class="field-item"> <span class="field-label">Phone Number</span> <span class="field-badge badge-basic"> <i class="fal fa-phone"></i> Phone Number </span> </div> <div class="field-item"> <span class="field-label">Date of Birth</span> <span class="field-badge badge-basic"> <i class="fal fa-calendar-alt"></i> Date Picker </span> </div> <div class="field-item"> <span class="field-label">Emergency Contact Name</span> <span class="field-badge badge-basic"> <i class="fal fa-font"></i> Short Text </span> </div> <div class="field-item"> <span class="field-label">Emergency Contact Phone</span> <span class="field-badge badge-basic"> <i class="fal fa-phone"></i> Phone Number </span> </div> </div> </div> <div class="fo-card"> <h3>Skin Type Assessment and Skincare History</h3> <p class="card-desc">Determine client's skin type, main concerns, and current skincare routine for treatment customization.</p> <div class="field-list"> <div class="field-item"> <span class="field-label">What is your skin type?</span> <span class="field-badge badge-choice"> <i class="fal fa-dot-circle"></i> Single Choice </span> </div> <div class="field-item"> <span class="field-label">What are your main skin concerns?</span> <span class="field-badge badge-choice"> <i class="fal fa-check-square"></i> Multiple Choice </span> </div> <div class="field-item"> <span class="field-label">Describe your current skincare routine</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Do you have any known allergies or skin sensitivities?</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> </div> </div> <div class="fo-card"> <h3>Medical History and Contraindications</h3> <p class="card-desc">Collect vital health information and identify contraindications that may affect treatment safety.</p> <div class="field-list"> <div class="field-item"> <span class="field-label">List any current medications, supplements, or topical treatments</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Do any of the following apply to you?</span> <span class="field-badge badge-choice"> <i class="fal fa-check-square"></i> Multiple Choice </span> </div> <div class="field-item"> <span class="field-label">How often are you exposed to sun/UV rays?</span> <span class="field-badge badge-choice"> <i class="fal fa-dot-circle"></i> Single Choice </span> </div> </div> </div> <div class="fo-card"> <h3>Treatment Goals and Consent Documentation</h3> <p class="card-desc">Understand client expectations and obtain necessary consent for safe, professional skincare treatments.</p> <div class="field-list"> <div class="field-item"> <span class="field-label">What are your main goals for today's treatment?</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Have you had professional facial treatments before?</span> <span class="field-badge badge-choice"> <i class="fal fa-dot-circle"></i> Single Choice </span> </div> <div class="field-item"> <span class="field-label">Preferred pressure for extractions and massage</span> <span class="field-badge badge-choice"> <i class="fal fa-dot-circle"></i> Single Choice </span> </div> <div class="field-item"> <span class="field-label">Any additional information or special requests?</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Consent acknowledgment</span> <span class="field-badge badge-choice"> <i class="fal fa-check-square"></i> Checkbox </span> </div> </div> </div> </div>

FAQ

What is an esthetician client intake form?

An esthetician client intake form is a comprehensive questionnaire that collects a client's health history, skin type, current skincare routine, allergies, medications, and contraindications before any facial or skincare treatment. It helps estheticians assess client safety and customize treatments appropriately.

What fields should an esthetician client intake form include?

Essential fields include contact information, skin type and concerns, current skincare products, known allergies and sensitivities, medications (especially Accutane, retinoids, blood thinners), pregnancy status, sun exposure habits, treatment goals, and a consent acknowledgment for potential reactions or side effects.

Can I customize this esthetician intake form?

Yes, you can fully customize the form by adding or removing questions, changing field types, updating colors and fonts to match your brand, adding your logo, and modifying the consent language. The AI makes customization simple through natural language commands.

Is this esthetician intake form free to use?

Yes, this form is completely free to create and use. There's no credit card required, no subscription fees, and unlimited responses. You can share it via link, embed it on your website, or print it for paper use at no cost.

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