What is the aesthetic treatment consent form template?
Aesthetic treatments move quickly from booking to chair, which makes a thorough, signed consent record essential. This template captures the treatment and areas, the client's goals and history, a medical suitability screen, and consent to treatment and photography — in one form the client can complete before arriving or on a tablet in clinic.
The suitability page asks the questions practitioners check before injectables and peels: pregnancy and breastfeeding, autoimmune and neuromuscular conditions, bleeding disorders, active skin infections, keloid scarring, recent dental work or vaccinations, cold sores, isotretinoin, blood thinners and recent sun exposure. Answering yes to pregnancy shows a short note that treatment is usually postponed.
The signed form is saved as a PDF in your FileIt vault, alongside every other client record.
- Best for
- Aesthetic clinics, medical spas, nurse injectors and skin clinics
- Filled in by
- The client, with the practitioner completing their details at the end
- Time to complete
- About 6 minutes
- Includes
- Treatment and area checklist, suitability screen, photo consent, three consent statements, signature
Who uses a aesthetic treatment consent form?
- Anti-wrinkle injection appointments
- Dermal filler for lips, cheeks or jawline
- Chemical peel and microneedling courses
- Recording photo consent separately for clinical records and marketing
- Pre-screening new clients at a medical spa
- Standardising consent across several practitioners or locations
Questions on this aesthetic treatment consent form
26 questions over 4 pages · includes signature, conditional questions, multiple pages, consent checkbox.
1 Your details
- Name*
- Date of birth*
- Phone*
- Email*
2 Treatment
- Treatment planned* Anti-wrinkle injections (botulinum toxin) · Dermal filler · Chemical peel · Microneedling · Skin booster · Thread lift
- Areas to be treated* Forehead · Frown lines · Crow's feet · Lips · Cheeks · Jawline or chin · Nose-to-mouth lines · Under-eye · Neck · Full face
- Treatment date*
- Practitioner
- What result are you hoping for?*
- Have you had aesthetic treatments before?
- What, where, when — and any reactions? asked only when it applies
- Do you have an important event in the next two weeks?
3 Medical suitability
- Are you pregnant, trying to conceive or breastfeeding?*
- Do any of these apply to you?* Autoimmune condition · Neuromuscular condition (e.g. myasthenia gravis) · Bleeding or clotting disorder · Skin infection, cold sore or active acne in the area · Tendency to keloid or raised scars · Facial surgery, dental work or vaccination in the last two weeks · Diabetes · History of severe allergic reaction · None of these
- Do you get cold sores?
- Have you taken isotretinoin (for acne) in the last six months?
- Current medication and supplements
- Allergies
- Sunburn, sunbed use or a fresh tan in the treatment area in the last two weeks?
4 Risks & consent
- Questions or concerns you'd like to discuss
- Before-and-after photos* For my clinical record only · For my record, and anonymised use in the clinic's marketing · I don't want photos taken
- My information*
- Risks explained*
- Consent to treatment*
- Client signature*
- Practitioner name and registration number
The aesthetic treatment consent form, page by page
1 Your details
Name, date of birth, phone and email.
2 Treatment
The treatment planned — anti-wrinkle injections, dermal filler, chemical peel, microneedling, skin booster, thread lift or other — and the areas to be treated. The date and practitioner, the client's hoped-for result, previous aesthetic treatments (with details if any) and whether there's an important event in the next two weeks.
3 Medical suitability
Pregnancy, trying to conceive or breastfeeding, with a note if yes. A checklist of relevant conditions, then cold sores, recent isotretinoin, medication and supplements (prompting for blood thinners and retinoids), allergies such as lidocaine, and recent sunburn or tanning.
4 Risks & consent
A plain summary of the side effects the practitioner will explain, space for questions, and a choice about before-and-after photos — clinical record only, record plus anonymised marketing, or none. The client confirms their information is accurate, that risks and aftercare were explained, and consents to treatment, then signs. The practitioner adds their name and registration number.
Make the template yours
- Edit the treatment list to match your menu
- Add product-specific risks for each treatment as extra paragraphs
- Add an aftercare acknowledgement or link to your aftercare sheet
- Change the photo options to match how your clinic uses images
- Collect a deposit or cancellation policy agreement as another consent
- Have your consent wording reviewed by your insurer or regulator
Tips for a better aesthetic treatment consent form
- Go through the risks in person even though the form summarises them
- Recheck suitability answers on the day, especially medication and recent vaccinations
- Keep photo consent separate from treatment consent, as the form does
- Store the signed PDF in the client's folder so repeat visits have history to hand
- Consider a cooling-off period between consultation and first treatment
Every response becomes a PDF in your vault
The signed form is saved as a PDF in your FileIt vault, and you get an email notification. Clients can receive their own copy.
Use the Responses table to check every client booked for the day has signed before they arrive.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Aesthetic treatment consent form: frequently asked questions
Is this aesthetic consent form free?
Yes. It's part of FileIt's Forms app on every account, including the free plan.
Which treatments does it cover?
It lists anti-wrinkle injections, dermal filler, chemical peels, microneedling, skin boosters and thread lifts, with an Other option. You can edit the list.
Does it ask about photo consent?
Yes. Clients choose between photos for their clinical record only, record plus anonymised marketing use, or no photos.
Can clients sign on a tablet in clinic?
Yes. Open the form link on any device and the client signs on screen.
Does it replace a face-to-face consultation?
No. It records what was discussed and agreed. The practitioner still assesses suitability and explains risks in person.
Is the wording legally reviewed?
No — it's a practical starting template. Have it checked for your jurisdiction and professional requirements.