Med Spa / Aesthetics Intake Form
Asks about client information, aesthetic areas of concern, and treatment goals & expectations. Built for medical spas and aesthetic medicine practices.
- Questions
- 16
- Pages
- 2
- Time
- about 4 min
Includes
- E-signature
- Consent agreement
- Medication list
- Allergy list
Your practice
Med Spa / Aesthetics Intake Form
Page 1 of 2 · Your information
Live preview. Tap through it like a patient.
Who it is for
- Medical spas and aesthetic medicine practices
- Cosmetic dermatology and anti-aging clinics
- Injectable and laser treatment centers
- Body contouring and non-surgical aesthetics practices
What's inside
Page 1 · Your information
- Client InformationText
- Date of BirthDate
- Phone NumberPhone
- Email AddressEmail
- Aesthetic Areas of ConcernLong Text
Page 2 · Additional details
- Injectable History (Botox/Filler)Long Text
- Current Skincare RegimenLong Text
- Sun Exposure & Tanning HistoryLong Text
- Contraindication ScreeningLong Text
- Accutane & Medication HistoryMedications
From form to a ready patient

01
Make it yours
Reword, reorder, or add to the Med Spa / Aesthetics Intake Form, and add your logo.

02
Patients finish it at home
A secure link by text or email, filled out on their phone before the visit. No app.

03
Your team sees who is ready
Each visit shows as ready once its forms are in. Answers land on the patient record.
Related templates
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Send it before the visit, so patients arrive ready.
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