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.
Skin Consultation Form Template UK Editable – PrintableSample
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
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WORD
Examples
[Name of the Client]
[Client’s ID]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
[Name of the Consultant]
[Consultant’s ID]
[Consultant’s Address]
[Consultant’s Phone]
[Consultant’s Email]
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.
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.
Select your skin type: [Oily, Dry, Combination, Sensitive, Normal]. Please describe any specific concerns you have regarding your skin.
Please list the skincare products you currently use, including cleansers, moisturizers, and any acne treatments.
Indicate the following lifestyle factors: [Diet, Hydration, Sun Exposure, Smoking, Stress Levels]. Describe how these factors may impact your skin health.
Please outline your desired outcomes from this consultation: [e.g., Improve skin texture, Reduce acne, Anti-aging treatment, etc.].
[Signature of the Client]
[Name of the Client]
[Signature of the Consultant]
[Name of the Consultant]
[Name of the Client]
[Client’s ID]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
[Name of the Consultant]
[Consultant’s ID]
[Consultant’s Address]
[Consultant’s Phone]
[Consultant’s Email]
This consultation form is intended to assist both the client and consultant in understanding skin concerns, conditions, and treatment requirements comprehensively.
Please list any skin-related medical conditions, allergies, or sensitivities that may affect your treatment: [Details].
Describe your current skin condition and any previous treatments: [A detailed account of past skincare treatments and reactions].
What are your primary objectives for this consultation? [E.g., Clear skin, Even tone, Hydration, etc.].
List all current skincare products including brand names and any concerns regarding their effectiveness: [Detailed listing of products and concerns].
Please share any other relevant information that may assist with your consultation: [Include additional notes, such as lifestyle, stress, or other health concerns].
[Signature of the Client]
[Name of the Client]
[Signature of the Consultant]
[Name of the Consultant]
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