Template: Medical IntakeEsthetician Client Intake Form Form TemplateUse This Template Collect necessary health, skincare history, and preference information from clients prior to an esthetic treatment.This is a preview of the template. Click here to use it.Full Name *Date of Birth *Contact Information (Phone or Email) *Emergency Contact (Name and Phone Number) What is your primary reason for today's visit? (e.g., skincare consultation, facial, acne treatment, anti-aging) *Do you have any specific skincare goals or areas of concern? How would you describe your skin type? *NormalOilyDryCombinationSensitiveDo you currently use any of the following products? (Check all that apply) CleanserTonerMoisturizerExfoliantSunscreenRetinoidsVitamin C SerumOther (please specify)If you selected 'Other', please specify Are you currently taking any medications or using topical prescriptions? *YesNoIf yes, please list your medications or topical prescriptions Do you have any known allergies or skin sensitivities (e.g., fragrances, ingredients)? Have you had any of the following procedures recently? (Check all that apply) Chemical PeelMicrodermabrasionLaser TreatmentBotox/FillersOther (please specify)If you selected 'Other', please specify Are you currently pregnant or nursing? *YesNoN/ADo you have any additional comments or concerns? Signature of Client *Sign HereDate of Submission *Use This Template