Medical Spa Intake Form

It has to be a clinical record, not a beauty questionnaire

A med spa performs medical procedures, which means the intake has to hold what a clinician needs to assess suitability - not just skin type and preferences. Blood thinners, autoimmune conditions, recent vaccinations, prior adverse reactions.

So this is longer than a beauty intake, deliberately, and it's split into steps so it doesn't read as a wall. It's also written to be completed once and updated rather than re-taken every visit - which is what makes a record useful over years.

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.

Yours to change, immediately

Nothing here is fixed. Rewrite a question, reorder them by dragging, add your brand colour, delete half of it. Save and the live form updates - there's no separate publish step and no deploy to wait for.

What this template asks

• Full name
• Date of birth
• Email address
• Phone number
• Address
• Emergency contact - name and number
• Doctor's name and practice
• Have you ever been diagnosed with any of these?
• Details, including when diagnosed
• Previous surgery and dates
• Are you pregnant or breastfeeding?
• All medication
• Supplements and herbal remedies
• Allergies and reactions
• Are you taking anything that thins the blood?
• Skin type
• Any of these?
• Are you using any of these?
• Recent sun exposure or sunbed use?
• Isotretinoin in the last 12 months?
• Do you smoke or vape?
• Alcohol
• I consent to a clinical assessment and consultation
• I understand any prescription treatment requires assessment by a prescriber
• The information above is accurate and complete, and I'll tell you if it changes

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