Esthetician Intake Form

Client Name*

Email Address*

Phone Number*

Date of Birth*

Skin Type*

Normal

Oily

Dry

Combination

Sensitive

Not Sure

Primary Skin Concerns*

Acne / Breakouts

Aging / Fine Lines

Hyperpigmentation

Redness / Rosacea

Dryness

Uneven Texture

General Maintenance

Current Skincare Routine

Allergies or Sensitivities

Are you currently using retinoids or prescription skincare?*

Have you had any recent cosmetic procedures?*

What is this form?

An esthetician intake form for skincare professionals to gather client skin history, concerns, allergies, and treatment goals before a facial or skin treatment.

Who is it for?

Estheticians, skincare clinics, spas, and beauty professionals offering facial and skin treatments.