Skin Consultation Form Template UK

The Skin Consultation Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, and features editable and printable samples for your convenience.

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Sample

Skin Consultation Form Template UK

Editable – Printable

PDF – 1 PDF – 2

Skin Consultation Form Template UK

1. Client Information





2. Medical History

3. Current Skin Concerns

4. Previous Treatments

5. Current Skincare Routine

6. Lifestyle Factors

7. Skin Type Assessment




8. Goals and Expectations

9. Consent for Treatment

10. Acknowledgment of Risks

11. Declaration and Signatures



PDF

WORD

Examples

Skin Consultation Form Template UK (1)
Client Information:
[Name of the Client]
[Client’s ID]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
Consultant Information:
[Name of the Consultant]
[Consultant’s ID]
[Consultant’s Address]
[Consultant’s Phone]
[Consultant’s Email]
Introduction:
This form is designed to gather essential information regarding the client’s skin health, concerns, and goals to provide a comprehensive consultation tailored to individual needs.
Section 1: Medical History
Please indicate if you have any of the following conditions: [Check if applicable: Eczema, Psoriasis, Rosacea, Acne, Allergies, etc.]. Include any medications currently being taken.
Section 2: Skin Type Analysis
Select your skin type: [Oily, Dry, Combination, Sensitive, Normal]. Please describe any specific concerns you have regarding your skin.
Section 3: Current Skin Care Routine
Please list the skincare products you currently use, including cleansers, moisturizers, and any acne treatments.
Section 4: Lifestyle Factors
Indicate the following lifestyle factors: [Diet, Hydration, Sun Exposure, Smoking, Stress Levels]. Describe how these factors may impact your skin health.
Section 5: Goals for Consultation
Please outline your desired outcomes from this consultation: [e.g., Improve skin texture, Reduce acne, Anti-aging treatment, etc.].
Signed in [City], [Date].
Sincerely,
[Signature of the Client]
[Name of the Client]
[Signature of the Consultant]
[Name of the Consultant]
Skin Consultation Form Template UK (2)
Client Information:
[Name of the Client]
[Client’s ID]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
Consultant Information:
[Name of the Consultant]
[Consultant’s ID]
[Consultant’s Address]
[Consultant’s Phone]
[Consultant’s Email]
Introduction:
This consultation form is intended to assist both the client and consultant in understanding skin concerns, conditions, and treatment requirements comprehensively.
Section 1: Personal Health Information
Please list any skin-related medical conditions, allergies, or sensitivities that may affect your treatment: [Details].
Section 2: Skin Condition Overview
Describe your current skin condition and any previous treatments: [A detailed account of past skincare treatments and reactions].
Section 3: Skincare Goals
What are your primary objectives for this consultation? [E.g., Clear skin, Even tone, Hydration, etc.].
Section 4: Product Usage
List all current skincare products including brand names and any concerns regarding their effectiveness: [Detailed listing of products and concerns].
Section 5: Additional Considerations
Please share any other relevant information that may assist with your consultation: [Include additional notes, such as lifestyle, stress, or other health concerns].
Signed in [City], [Date].
Sincerely,
[Signature of the Client]
[Name of the Client]
[Signature of the Consultant]
[Name of the Consultant]

Printable

PDF – 1 PDF – 2

Skin Consultation Form Template UK