Med Spa / Aesthetics Intake Form

The Med Spa / Aesthetics Intake Form is specifically designed for medical spa and aesthetic medicine practices, capturing the detailed cosmetic history and safety screening that med spa providers need for safe and satisfying treatment outcomes. This template collects client demographics alongside an aesthetic goals assessment covering areas of concern (fine lines, wrinkles, volume loss, skin laxity, pigmentation, acne scarring, texture, body contouring), desired outcomes, and treatment timeline expectations. The Fitzpatrick skin type classification helps providers select appropriate laser parameters and assess treatment risk.

Built for medical spas, cosmetic dermatology, aesthetic nursing, and anti-aging practices, this form includes sections for prior aesthetic treatment history (Botox, dermal fillers with product names and dates, chemical peels, microneedling, laser treatments, IPL, CoolSculpting, PRP), satisfaction with previous results, current skincare regimen and products, sun exposure habits and tanning history, medication review (Accutane history, blood thinners, photosensitizing medications), allergy history (lidocaine, latex, adhesive), pregnancy and breastfeeding status, autoimmune conditions, history of cold sores (relevant for lip treatments), and keloid or hypertrophic scarring tendency.

All fields are HIPAA-compliant and structured for the med spa consultation workflow. The photo consent section authorizes before-and-after documentation, social media usage, and marketing materials, with clear opt-in/opt-out options. Pre-visit completion enables the provider to review the client's aesthetic history, identify any contraindications, and prepare a customized treatment plan that addresses their specific cosmetic goals safely and effectively.