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
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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.
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.
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