Med Spa Consultation Form

Previous injectables, by product and date

Someone who had filler eighteen months ago from a practitioner they can't name, in a product they don't know, is a genuinely different clinical proposition from a first-time client. Filler migrates, sits, and interacts - and treating over it blind is how results go wrong.

So this template asks what was used, where, when and by whom. It also asks what the client expects to see, because managing an unrealistic expectation is much easier before the appointment than after the treatment.

What a good intake form saves you

The first message from a new client almost never contains what you need. You reply asking one question; they answer a different one; a week later you still can't start. Every round trip is a day, and the clients who go quiet are usually the ones who got tired of answering.

One form ends that. Ask everything once, get a complete picture, and start the same day. The questions in this template are the ones you end up asking anyway - the form just gets them asked up front.

Health screening that protects the treatment

Pregnancy, recent surgery, medication, injuries, pressure preference - the questions that decide whether a treatment is safe and whether it will be enjoyed. Asked at the door they get a shrug; asked in advance they get an answer.

The form is also where you set expectations: arrival time, cancellation terms, what to expect. Written down once, it stops most of the awkward conversations at the desk.

Fast enough that people finish it

Abandonment is mostly a speed problem. A form that takes a second to appear and submits in one request gets finished; one that loads a framework first does not. This is a single self-contained page - no scripts to download, nothing to wait for.

One minute to make it your own

Every label, option and placeholder on this template is editable, and you can add whatever this template doesn't ask. Save to publish, share the link, and export the responses whenever you need them in a spreadsheet.

What this template asks

• Full name
• Date of birth
• Email address
• Phone number
• Your doctor's practice
• What are you interested in?
• What would you like to change?
• How long have you been thinking about it?
• What do you expect to see afterwards?
• Is there an event you're preparing for?
• Have you had injectable treatments before?
• What, where, when and by whom?
• Have you ever had a complication or a result you disliked?
• Anything else in the last 6 months?
• Do any of these apply?
• All medication and supplements
• Allergies
• Have you taken isotretinoin in the last 12 months?
• I understand a prescriber must assess me before any prescription treatment
• I understand results vary between individuals and cannot be guaranteed
• The information above is accurate and complete

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