• Facial Pre-Consultation Form for Specialist

    Professional intake form for a medical spa facial. Please complete the client information, medical and aesthetic history, skin evaluation, consent, signature, and aftercare instructions.

  • Client Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Medical History

  • Do you have or have you had any of the following?*

  • Current Medications

  • Are you currently taking any of the following medications?*
  • Have you recently had any of the following procedures?

  • Recent Aesthetic Procedures

  • Are you currently taking any other medication?*

  • Aesthetic History

  • Have you had facial treatments before?*

  • Skin Evaluation

  • Skin Type*
  • Skin Conditions*

  • Photo Consent

  • I authorize the use of my before-and-after photos for clinical documentation purposes*
  • I authorize the use of my before-and-after photos for marketing purposes (social media, website, promotional materials)*
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  • Upload Photos
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  • Please read and confirm that you have followed these recommendations before your facial treatment:

    1. Avoid intense sun exposure
    - Do not sunbathe or use tanning beds for at least 48–72 hours before.
    - Avoid arriving with skin that is burned, irritated, or sensitized.

    2. Stop active products
    - Do not use products with retinol/retinoids.
    - Do not use acids such as AHA, BHA, glycolic, or salicylic acid.
    - Stop them at least 3–5 days before the facial.

    3. Do not undergo other aggressive treatments
    - Avoid facial waxing or threading.
    - Avoid chemical peels.
    - Avoid laser or microdermabrasion.
    - Have these treatments at least 5–7 days before.

    4. Clean skin
    - Arrive with a clean face and no makeup.
    - If that is not possible, a basic cleansing will be done before treatment.

    5. Avoid recent exfoliation
    - Do not exfoliate the skin during the 48 hours prior.

    6. Report skin conditions
    - Notify us if you have active severe acne breakouts.
    - Notify us if you have wounds, irritation, or infections.
    - Notify us of allergies or recent sensitivity.

    7. Medication
    - Inform us if you are using medications such as isotretinoin (Accutane).
    - Inform us if you use antibiotics or dermatological treatments.
    - Please check beforehand if you take any medication that may affect the treatment.

    8. Hydration
    - Drink enough water the day before for better skin results.

    9. Important
    - If you had a recent skin reaction or a recent aesthetic procedure, let us know before your appointment.
    - This information helps ensure your safety and allows the treatment to be properly adapted.

  • VERY IMPORTANT (LEGAL PROTECTION)

  • Informed Consent

  • I, the undersigned, declare that the information provided is true and complete. I understand that facial treatments do not replace medical care and that I must inform my specialist of any changes in my health condition. I acknowledge that the possible benefits, risks, and side effects of the facial treatment have been explained to me and that all my questions have been answered. I authorize the staff of this medical spa to perform the facial treatments deemed appropriate for my case, and I release the facility and its staff from any liability arising from omissions or incomplete information that I have provided.
  • ⚠️ Note: Some treatments may be modified or postponed depending on your medical history to ensure your safety.
  • I confirm that I have truthfully disclosed my medications and aesthetic procedures. I understand that withholding this information may affect my treatment and results.

  • Digital Signature

  • Date*
     - -
  • Should be Empty: