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Esthetician Treatment Consent Form

Document your clients' authorization before performing esthetic treatments, along with their allergies, medications and everyday skincare products. Digitally signed for your records.

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Client name

Nombre

Apellido

Date of birth

Phone number

Email address

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Esthetician's name

Nombre

Apellido

Health background

Are you presently taking any medications?

Yes No Prefer not to say

Are you pregnant?

Yes No Not sure

Do you have any allergies to cosmetics, food or drugs?

Yes No Not sure

Please specify

What skin care products do you currently use?

Cleanser Toner Moisturizer Sunscreen Serum Exfoliant Retinol None

Please specify

Have you had skin cancer?

Yes No Prefer not to say

Do you use acne medication?

Yes No In the past

Are you taking oral contraceptives?

Yes No Prefer not to say

Please check if you are affected by or have had any of the following

Eczema Psoriasis Rosacea Cold sores Keloid scarring Recent sunburn Recent Botox or fillers None

Consent statement

Client signature

Sign here

Date

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