Facial consent form template
A facial intake and consent form in one: the skin history an esthetician needs to choose a safe treatment, and the client's signed consent. Print it, or save it as a PDF from the print dialog.
Facial consent form
Contact details
Full name
Phone
Date of birth
Address
Your skin
Skin type
Main concerns or goals (acne, dryness, pigmentation, aging)
Products you use daily
Before your facial
Are you currently using any of these?
In the last two weeks, have you had any of these?
Are you pregnant or breastfeeding?
YesNoAllergies or sensitivities to skincare ingredients
Consent
I have answered the questions above accurately and will tell my esthetician about any changes before treatment.
I understand that facial treatments can cause temporary redness, dryness or sensitivity, and that results vary. I consent to the treatment discussed with my esthetician and to the aftercare instructions I have been given.
Signature
Date
Sections
Choose “Save as PDF” in the print dialog to download. Nothing you type leaves your browser.
Use it on your website
Put the short version online. AI calls them back in 60 seconds.
Long forms on a phone get abandoned. With RingOwl, your website asks three questions. If the visitor ticks “call me back”, your AI calls within a minute, asks the rest of this form, books the appointment and saves a complete record, with their consent on file.
Test the callback in your browser during the trial. Phone callbacks need a paid plan (US, Canada, UK, Australia and India numbers).
On your website
- Full name
- Phone
- Which facial are you interested in?
- “Call me back within a minute” box
Asked on the AI callback
- Main skin concerns or goals
- Using retinoids, Accutane or exfoliating acids right now?
- Known skin allergies or sensitivities
- Pregnant or breastfeeding?
- First facial with us?
- Preferred day and time
How to get the most out of a facial consent form
- Ask about retinoids and Accutane at booking
- Some treatments aren't suitable for skin on these products. Knowing in advance avoids turning someone away at the treatment bed.
- Separate intake from consent
- Collect the skin history when they book; have them sign the consent in the studio after the esthetician has explained the treatment.
- Review the wording for your services
- This is a starting template, not legal advice. Check it against your state board's rules and your insurer's requirements.
Facial consent form FAQ
What is a facial consent form?+
It's a form where the client confirms their skin history is accurate and agrees to the treatment after it has been explained. It's usually combined with an intake section covering skin type, products in use and recent treatments.
What should a facial intake form ask?+
Skin type and concerns, current products (especially retinoids, Accutane and exfoliating acids), recent peels, laser or waxing, pregnancy, and allergies to skincare ingredients.
Do estheticians need clients to sign a consent form?+
Requirements vary by state and by insurer, so check yours. Most estheticians use one anyway: it documents that the client disclosed their history and agreed to the treatment.
Is this template legally binding?+
It's a starting point, not legal advice. Have it reviewed against your state board's rules and your insurance policy before you rely on it.
The consent wording on this template is a starting point, not legal advice. Have it reviewed for your state, your licensing board and your insurer.
More free intake form templates