Facial Consent Form
Consent and intake form for facial treatments including chemical peels, microdermabrasion, and standard facials. Covers skin type, sensitivities, and product allergies.
Last updated: April 2026
Researched by the CheckinPulse Research Team
Use This Form Digitally
Paper forms work, but digital forms work better. Here is what you get when you use this template on CheckinPulse:
Clients fill out on their phone (no app needed)
Scan a QR code or tap a link — works on any device
E-signatures with legal timestamp
IP address, timestamp, and audit trail on every signature — valid in all 50 states under the E-SIGN Act
Submissions go straight to your dashboard
No more clipboards, filing cabinets, or illegible handwriting
PDF waivers stored for 7 years
Encrypted, searchable, and accessible anytime on paid plans
Form Preview
This is what your clients will fill out. 13 fields, mobile-friendly.
Facial Consent Form
All fields marked with * are required
Consent / Waiver Language
This waiver text is included at the bottom of the form, above the signature field.
I consent to the facial treatment described above and acknowledge that skin reactions including redness, irritation, peeling, breakouts (purging), and sensitivity may occur. I have disclosed all skincare products, medications, and recent procedures. I understand that certain treatments are contraindicated with Retinol, Accutane, and recent injectables. I release the service provider from liability for adverse reactions resulting from undisclosed information.
Legal References
The federal law that makes electronic signatures on consent forms and waivers legally equivalent to handwritten signatures in all 50 US states.
Frequently Asked Questions
Skin type, current products (especially retinoids), allergies, recent procedures (Botox, fillers, laser), pregnancy status, and acknowledgment that redness or purging can happen. The retinoid question is the most critical — doing a chemical peel on someone using tretinoin can cause chemical burns.
One form works for most facial services. Just include a field for which treatment they're getting. If you offer advanced treatments like chemical peels or microneedling, you might want a supplemental section with additional risk disclosures for those.
Most providers wait 2-4 weeks after Botox or filler before doing facial massage, extractions, or treatments that involve pressure. Your consent form should ask when their last injectable was — if it's under 2 weeks, reschedule or adjust the treatment.
This form includes chemical peel as a service option with appropriate risk disclosures. For deeper peels (TCA, Jessner), some providers add a separate addendum with more detailed risks. For light peels and enzyme treatments, this form covers it.
Popular with salon and esthetics owners — see how CheckinPulse serves your industry.
Ready to go paperless?
Turn this template into a digital form your clients fill out on their phone. E-signatures, auto-saved PDFs, and a dashboard to manage everything. Free to start.
Start free — no card neededRelated Templates
Waxing Consent Form
A consent form for waxing services covering skin sensitivity, allergies, and aftercare instructions. Ready to use for any waxing salon or esthetician.
Lash Extension Consent Form
Consent form for eyelash extension services including allergy disclosures, adhesive sensitivity warnings, and aftercare acknowledgment.
Botox Consent Form
Informed consent form for Botox and neurotoxin injections. Covers risks, contraindications, expected results, and post-procedure instructions.
Lash Consent Form
General consent form covering all lash services — extensions, lifts, and tints. Includes allergy screening and aftercare acknowledgment.