Facial Treatment Consent Form
Skin-history, contraindication, and Fitzpatrick documentation for facials, chemicals peels, and microneedling.
What's inside
- Skin type + Fitzpatrick scale
- Medication & Accutane history
- Sun-exposure disclosure
- Treatment plan + expected results
- Signature block
FACIAL TREATMENT CONSENT Client: ______________________________ Date: ___________ Esthetician: __________________________ SKIN PROFILE Fitzpatrick type: [ ]I [ ]II [ ]III [ ]IV [ ]V [ ]VI Primary concerns: __________________________________ MEDICAL HISTORY Currently using: [ ] Retinoids [ ] AHAs/BHAs [ ] Antibiotics [ ] Accutane (past 6 mo) Pregnant or breastfeeding? [ ] Yes [ ] No Recent sun exposure or tanning bed in last 7 days? [ ] Yes [ ] No TREATMENT PLAN Service: ____________________________ Expected results: ____________________________ Possible reactions: redness, peeling, stinging, transient hyperpigmentation CONSENT I confirm the information above is accurate and consent to the planned treatment. Client signature: ___________________________ Esthetician signature: ______________________ DISCLAIMER: This template is provided for informational purposes only and does not constitute legal, medical, or financial advice. Have a licensed professional in your jurisdiction review and adapt it before use.
FAQ
Should clients re-sign each visit?
Yes — for any chemical or invasive service. A short update form is enough for routine facials.
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Use facial treatment consent form inside Beautifyx — auto-sent, e-signed, stored with the client.
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