The same skincare treatment can produce very different results from one client to another, depending on their skin type and condition. So, before recommending a treatment, a skincare specialist needs to understand a person’s skin behavior, medical history, lifestyle habits, and current skincare routine. An esthetician’s client intake form helps collect this information before treatment begins.
Whether you are an esthetic clinic owner or an independent skincare provider, this esthetician client intake form from WordLayouts can be customized to suit your requirements. Available in Google Docs and Word, it is fully editable, printable, and can be adapted for different practice areas.
So, instead of starting from scratch, download the template and get started!
What Is an Esthetician Client Intake Form?
An esthetician client intake form is an official document used by skincare professionals to collect important information from clients before treatment. It records:
- Personal details
- Medical history
- Allergies
- Skin type
- Current skincare routine
- Lifestyle habits
- Treatment goals
- Consent
These details help estheticians make informed treatment decisions based on the client’s skin concerns, history, and goals. It further helps ensure the client’s safety and provides personalized skincare treatments in order to prevent adverse reactions. All this helps in achieving the client’s goals, ensuring product compatibility, and improving the effectiveness of the treatments.
Moreover, it also creates a track record of the client data for future appointments, so that you don’t have to retake history in case they come back.
A Closer Look at Your Client’s Skin Profile
Unlike many other beauty intake forms, esthetician intake forms are designed to collect information that directly influences treatment choices. They act as a building base for the whole process and provide a closer look at the client’s skin profile. From identifying lifestyle habits to reviewing previous cosmetic procedures, the form helps create a more complete picture of the client’s skin health before treatment begins.
- Skin Health Focus: The form gathers information about clients’ skin type, skin concerns, product usage, sun exposure, and reactions.
- Lifestyle Assessment: It also records the client’s diet, water intake, sleep, stress, alcohol, and smoking habits, and how they are affecting their skin.
- Gender-Specific Questions: It further allows for a more personalized assessment by including female-specific questions and male-specific sections.
- Treatment Readiness Screening: Lastly, it identifies potential contraindications by recording recent procedures and skin care the client uses.
All these insights can help any skin care specialist have a complete understanding of their client’s skin to evaluate it and make informed, confident recommendations.
Inside This Esthetician Intake Form
The template is easy to complete and uses fields and checkboxes throughout the template. It further follows a logical assessment process and is mainly divided into 9 sections.
- Client details
- Allergies and reactions
- Skin type and condition
- Current skincare routine
- Lifestyle and environmental factors
- Gender specific questions
- Treatment preferences
- Consent to treatment, photography and release
- Survey
Client details
In the top right corner, the template provides space for the date and checkboxes to select whether the client is new or existing.
Following that, it records the client’s personal details such as name, DOB, gender, phone no, email address, and address. This information supports record-keeping and makes client communication easier.
It also includes fields for alternate contact name, relationship with client, and phone number. This section is included in almost all healthcare-adjacent client intake forms, such as a massage client intake form or a nursing assessment form, for emergency purposes.
Allergies and reactions
This section gathers information about the kind of allergies, ingredient sensitivity, reactions, medical conditions, medication, and procedures the client has.
Initially, it inquires about the client’s known allergies. It could be a food allergy, medications, skin care products, latex, etc. The client can simply select the appropriate option and use the field to specify the allergy and relevant details. It can help reduce the risk of ingredient-related reactions during treatment.
It further includes questions about ingredient sensitivity and includes options such as retinol/vitamin A, alpha hydroxy acids (AHAs), beta hydroxy acids (BHAs), essential oils, fragrances/perfumes, and others. In the “other” option, the client can write down any ingredient to which they are allergic.
Next, it inquires whether the client has ever experienced a reaction to any skincare product or treatments (redness, swelling, etc) or has any medical conditions (diabetes, heart condition, high blood pressure, skin conditions, autoimmune disorders, cancer, seizures, and any other). It is quite significant to know all this because some conditions affect treatment suitability.
Lastly, it includes fields for any current medications the client is taking, or any dermatology treatments and cosmetic procedures they have undergone. All these questions include yes and no options. The user can simply select the option and write details in the field.
Skin type and condition
After gathering medical and allergy information, the template shifts its focus to skin assessment. This section asks the client to describe their skin type and provides seven options: normal, oily, dry, combination, sensitive, enlarged pores, and other. The “other” field allows the client to specify a skin type that isn’t already listed.
Then it asks how the skin reacts to sun exposure to get insight into skin sensitivity. It includes five checkboxes with “always burns,” “usually burns,” “sometimes burns,” “rarely burns,” and “never burns” options. The client can simply tick the option that best explains their sun response.
Next, to know the primary skin concerns, the template asks, “What concerns do you have regarding your skin?” and gives options: acne/breakouts, blackheads/whiteheads, fine lines/wrinkles, hyperpigmentation, redness, dryness/dehydration, and other (specify your concern if not already listed in options).
Current skin care routine
The next section focuses on the client’s current skin care routine and recent skin-related treatments.
At the start, the template asks how often the client exfoliates or uses treatment products at home. It also includes space to list the skin care products currently being used, including brand names where known. The form also asks whether the client regularly uses SPF and whether they have recently used self-tanning products. Sun protection habits and recent tanning treatments can affect the condition and appearance of the skin.
The template further asks about recent hair removal methods, including shaving, waxing, threading, tweezing, electrolysis, and depilatory products. Since some esthetic procedures should not be performed immediately after certain hair removal treatments, knowing this information can help determine whether additional precautions or waiting periods may be necessary.
Another important part of this section focuses on prescription and active skin care products. Clients can indicate whether they currently use products such as Accutane, Retin-A, Tretinoin, Adapalene, topical Vitamin A, topical Vitamin C, scrubs, peels, or other active ingredients because these products can affect skin sensitivity and recovery.
The template also asks if the client has recently received Botox, fillers, chemical peels, laser treatments, or microdermabrasion services and whether they have visited a dermatologist within the past year.
Lifestyle & environmental factors
This section is dedicated to different lifestyle and environmental factors that can have a significant impact on skin health.
This part lists options with checkboxes, giving the client the option to select what best fits their situation. For the client’s typical diet, it mentions balanced, high protein, high carbs, low carbs/keto, veg/vegan, fast food/processed, and irregular. For water intake, it includes 4 options: less than 1 liter, 1-2 liters, 2-3 liters, and more than 3 liters. For stress level, it mentions 5 levels ranging from relaxed to overwhelming.
Similarly, for sleep habits, it mentions the following options:
- Less than 5 hours
- 5-6 hours
- 6-7 hours
- 7-8 hours
- 8+ hours
It then includes questions about smoking, alcohol consumption, and sun exposure with relevant options, and the client can select whatever fits their situation best. These factors can significantly affect skin condition and may influence treatment outcomes if they are not taken into consideration.
Gender specific questions
This section is entirely optional and is included to gather information that may be relevant to certain clients. It includes some gender-specific questions that are totally up to the client to fill out or not.
Female client questions (optional)
For female clients, it includes questions about whether they are on any contraceptive medication or treatment, or whether they have recently changed their contraceptive treatments. The template gives two options, yes or no, along with a detailed field to write an answer. It also includes a question about the client’s current situation, i.e., pregnancy, nursing, menopause, and hormone replacement therapy. This section is added because hormonal factors can affect skin condition.
Male client questions (optional)
The template also includes a short optional section for male clients. While skin assessments often focus on skin type, product usage, and treatment history, daily shaving habits can also play an important role in overall skin condition.
It includes two questions:
- What type of shaving system do you currently use:
- Wet Shave
- Electric Shaver
- Other
- Do you experience any of the following issues after shaving?
- Irritation: Yes or No
- Ingrown Hairs: Yes or No
Although optional, this section can provide useful insight into grooming habits and shaving-related concerns that may not be identified during a standard skin consultation.
Treatment preferences
Another important factor that can impact the treatment selection is the client’s skin goals. In this section, the template includes certain questions that can help a skincare provider know what their client wants. First, it asks about the client’s primary skincare goals. It gives options such as deep cleansing/detox, hydration, anti-aging, acne, brightening, relaxation, and others (if the goal is not in the list, the client can specify here).
It also asks about fragrance preferences or sensitivity, with unscented/neutral, light/natural scent, no preference, and sensitive/allergic to fragrance as options.
Next, the template asks clients to indicate their preferred pressure level during facial treatments, with options ranging from light to firm pressure. The form further asks whether any areas of sensitivity or discomfort should be avoided. This helps estheticians approach sensitive areas with additional care.
The template also provides space for clients to list any skin care brands or products they prefer or wish to avoid. This information can be useful when discussing home care routines, product recommendations, or known sensitivities to certain ingredients or formulations.
Lastly, the form asks how often the client would like to schedule esthetician appointments, with options including weekly, biweekly, monthly, or as needed.
Consent
This section helps document informed consent and confirms that the client understands the information provided throughout the form. By signing this section, the client confirms that:
- The client read and understood the questionnaire
- Agrees to inform the esthetician of any changes in health, medication, and skin care routine
- Understands that this constitutes full disclosure and replaces previous verbal and written disclosure
- Understands that hiding information can have adverse reactions
- Treatment is voluntary and releases the establishment (skincare clinic) and staff from liability
- The esthetician reserves the right to defer or refuse treatment if any contraindications are identified.
- Understand the risks and benefits of treatment
- Consent to proceed with treatment
- Consent or decline consent for before-and-after photographs
- Consent to use the picture for marketing purposes
Lastly, it includes space for a signature and date.
Survey
Lastly, the template includes a short survey section. It asks how the client heard about your business and whether they would like to receive email promotions and updates. This information can help evaluate marketing efforts while supporting future client communication.
Customize the Form for Your Specialty
This esthetician client intake form is fully editable and can be customized to fulfill different businesses’ branding needs, service offerings, and practice requirements.
- In the case of a skincare clinic, you can add a logo, business name, contact information, website, and social media to improve your business branding.
- You can also add or extract questions according to your practice requirements. For example, for facial-focused practices, it’s better to expand on skin concerns, product usage, and the acne assessment section. If you are an acne specialist, it’s better to know more about the client’s hormonal acne, medication history, and diet questions. Similarly, you can also use this form for spa esthetics or medical esthetics.
- This template can also be used digitally. Simply download the form in your preferred file format, customize it, convert it into a fillable PDF, and use it as an online intake form on tablets, mobile, or any other device. You can also upload it to client portals and add an electronic signature if required, and clinics that share client data with outside vendors may also want a non-disclosure agreement in place.
Who Can Use This Template?
No client intake form can be truly “one-size-fits-all,” but this template can be modified to be used by a wide range of skincare professionals. Whether you are a solo skincare provider, have a skincare clinic, or work freelance, this can be altered to fit your needs. Mainly, it can be used by:
- Licensed estheticians
- Medical estheticians
- Skincare specialists
- Facial studios
- Day spas
- Med spas
- Beauty salons
- Wellness centers
- Dermatology clinics offering esthetic services
- Independent skincare professionals
Esthetician vs. aesthetician: what’s the difference?
Although the terms “esthetician” and “aesthetician” are often used interchangeably, they typically refer to different areas of practice. Estheticians primarily focus on cosmetic skin care services and commonly work in spas, salons, or independent skincare practices. Their services may include facials, cleansing and exfoliation treatments, hair removal, facial massage, skincare consultations, and product recommendations.
Aestheticians, sometimes referred to as medical aestheticians, generally work in medical environments such as dermatology clinics, plastic surgery offices, hospitals, or rehabilitation centers.
Because this template focuses more on gathering information about skin type, skin care routines, sensitivities, treatment preferences, and cosmetic services, it is primarily designed for estheticians and skincare professionals working in non-medical settings.
Licensing requirements
In the United States, estheticians’ licensing is governed by state law, and requirements vary depending on the state. Estheticians are generally required to obtain a license from the appropriate state regulatory authority, such as a state board of cosmetology or a similar licensing agency.
To become a licensed esthetician, individuals are required to complete a state-approved esthetics training program and pass the applicable licensing examination. Some states also recognize apprenticeship programs as an alternative or supplemental training pathway.
Common requirements include:
- Meeting the state’s minimum age requirements
- Holding a high school diploma or equivalent (required in some states)
- Completing the required number of esthetics training hours
- Completing an apprenticeship, where permitted
- Passing the state licensing examination
Always consult your state’s cosmetology or licensing board for the most current requirements or see the NIC State Board Directory to locate your state’s licensing authority.
Conclusion
Better skin assessments start with complete and updated client information. From skin concerns and product usage to lifestyle habits and treatment history, this template helps bring all the details together before treatment begins.
This template is designed to support both new and returning clients and can be adapted to cater to a variety of skincare businesses. Available in Microsoft Word and Google Docs formats, the template can be used digitally or printed for in-person consultations. Simply download it, customize it to fit your services, and create a more organized and informed client experience.
