Esthetician Client Intake Form

Esthetician Client Intake Form Template for South Africa

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Key Requirements PROMPT example:

"I need an Esthetician Client Intake Form for my new medical spa in Johannesburg, opening in March 2025, that includes sections for advanced skin treatments and laser procedures, with extra emphasis on medical history and contraindications."

Document background

The Esthetician Client Intake Form is a crucial document used in South African beauty and wellness establishments to gather comprehensive client information before providing esthetic services. It serves multiple purposes: ensuring compliance with South African healthcare regulations and POPIA requirements, documenting client medical history and skin conditions, obtaining informed consent for treatments, and establishing a legal record of the client-practitioner relationship. This form should be completed before the first treatment and updated periodically to maintain accurate records. It includes sections for personal information, medical history, skin assessment, and various consent requirements specific to South African law.

Suggested Sections

1. Personal Information: Client's basic contact details, including name, address, phone, email, and emergency contact information

2. Medical History: Comprehensive health information including current medications, allergies, medical conditions, and recent surgeries

3. Skin Assessment: Current skin conditions, concerns, routine, and products used

4. Lifestyle Factors: Information about sun exposure, diet, stress levels, and other factors affecting skin health

5. Treatment History: Previous aesthetic treatments, reactions, and outcomes

6. Consent and Acknowledgment: Client's agreement to treatment and acknowledgment of risks

7. Privacy Notice: POPIA-compliant information about how personal data will be collected, stored, and used

8. Client Declaration: Client's confirmation that all provided information is accurate and complete

Optional Sections

1. Pregnancy Information: Additional section for pregnant or nursing clients, detailing specific considerations and restrictions

2. Photography Consent: Optional permission for before/after treatment photographs

3. Marketing Preferences: Client's preferences for receiving promotional materials and communications

4. Minor Client Information: Additional section for clients under 18, including parent/guardian details and consent

5. Special Treatment Considerations: For clients with specific conditions requiring modified protocols

Suggested Schedules

1. Schedule A: Treatment Menu: List of available treatments and their descriptions

2. Schedule B: Contraindications List: Comprehensive list of conditions that may prevent treatment

3. Schedule C: Post-Treatment Care Instructions: Standard aftercare guidelines for various treatments

4. Appendix 1: Product Sensitivity Test Record: Documentation of patch tests and sensitivity checks

5. Appendix 2: Treatment Consent Forms: Specific consent forms for different treatment types

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Beauty and Wellness

Healthcare

Medical Aesthetics

Spa and Recreation

Professional Services

Cosmetic Industry

Personal Care Services

Relevant Teams

Operations

Client Services

Medical Aesthetics

Compliance and Legal

Quality Assurance

Front Desk

Treatment

Administration

Customer Relations

Relevant Roles

Esthetician

Skincare Specialist

Spa Manager

Beauty Therapist

Medical Esthetician

Salon Owner

Compliance Officer

Beauty Clinic Administrator

Dermal Therapist

Treatment Coordinator

Quality Assurance Manager

Client Relations Manager

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Let's create your Esthetician Client Intake Form

Authors

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