Facial Consent Form Template
A free facial consent form for estheticians and skin studios. Clients share skin goals, products and contraindications, then sign before treatment.
Customize the pages and design to fit your needs.
About this template
Collect the treatment, skin concerns, current products and the contraindications estheticians check before a facial, peel or dermaplaning. Clients read the consent and release, then sign online.
Common uses
- Estheticians and skin studios
- Chemical peels and dermaplaning
- New client intake at day spas
Key features
- Contraindication checklist
- Skin goals and routine
- Cosmetic only and results terms
What this template asks
What's your full name?
Short Text
What's your date of birth?
Date
What's your email address?
Email
What's your phone number?
Phone
Which treatment are you booked for?
Single Choice · Classic facial, Hydrating facial, Acne facial, Chemical peel, Microdermabrasion, Dermaplaning, Not sure yet
Which skin concerns would you like to work on?
Multiple Choice · Optional · Acne or breakouts, Dryness, Fine lines, Dark spots, Redness or sensitivity, Large pores
Do any of these apply to you?
Multiple Choice · Retinol or prescription retinoids, Isotretinoin in the last 12 months, Injectables or laser in the last 2 weeks, Cold sores, Active skin infection or rash, Pregnant or nursing, Allergies to skin products, None of these
What's in your skin care routine?
Long Text · Optional
Facial treatment consent and release
Agreement text, accepted with “I agree”
Sign the facial consent
Signature
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Facial treatment consent and release
Signers read this text in the form before they accept it. Edit the bracketed details to match your business, and have the wording reviewed for your situation.
Please read this before you sign.
This consent is between [Studio name] (the "Studio") and the client named in this form.
- Health. I have answered the skin and health questions truthfully and will tell my esthetician about any change before future treatments.
- Risks. I understand treatments can cause redness, peeling, breakouts, sensitivity or, rarely, changes in skin color, and that peels and exfoliation carry more risk with retinoids or recent sun.
- Results. Results vary by skin type and routine, and a series of [number] treatments may be recommended.
- Aftercare. I will follow the aftercare I am given, use sunscreen, and avoid exfoliating products for [number] days after a peel.
- Not medical care. Treatments are cosmetic. They do not diagnose or treat medical skin conditions, and I will see a doctor for those.
- Release. I release the Studio and its staff from claims arising from the treatment, except for their negligence.
By signing below, I confirm that I have read this consent and agree to it.
Frequently asked questions
What contraindications should a facial consent form ask about?
Retinoids, isotretinoin, recent injectables or laser, cold sores, active infections, pregnancy and product allergies. The checklist covers each one.
Does it work for chemical peels and dermaplaning?
Yes. Clients pick the treatment, and the risk and aftercare terms cover peels and exfoliation. Edit the bracketed days to match your protocol.
Is this a medical form?
No. It's for cosmetic treatments by estheticians. Med spas offering medical procedures should use the forms their medical director requires.