Client Consultation & Consent Form

💅 [Business Name] 👤 Therapist: [Your Name] 📅 Date: [Date]

Please complete this form as fully as possible. All information is kept strictly confidential and is used solely to provide you with safe, appropriate treatment. Medical data is processed under UK GDPR — see our Privacy Notice for details.

Section A — Client Details (completed by client)

Full name

Date of birth

Address (first line & postcode)

Phone number

Email address

Emergency contact name & number (optional)

How did you hear about us?

Section B — Medical History (completed by client)

Please tick any conditions that apply to you and provide details where prompted. If you are unsure whether a condition is relevant, please mention it and your therapist will advise.

Skin condition (e.g. eczema, psoriasis, rosacea)

Known allergies (products, latex, metals)

Sensitive skin

Active acne / breakouts in treatment area

Cold sores / herpes simplex

Keloid scarring tendency

Fungal / bacterial nail infection

Diabetes

Blood-thinning medication (e.g. warfarin, aspirin)

Medication affecting skin/nails (e.g. Roaccutane, steroids)

Recent surgery or injury in treatment area

Open wounds, cuts, or abrasions

Pregnancy

Cancer / undergoing chemotherapy or radiotherapy

Circulatory / heart condition

Epilepsy

Please provide details of any conditions ticked above (include medication names where relevant)

Any known allergies or previous reactions to beauty products?

Current medications (including topical creams, supplements, contraceptives)

Section C — Lifestyle & Skin Health (completed by client)

Current skincare routine (briefly)

Water intake (approx. litres per day)

Sun exposure / recent holidays / sunbed use

Occupation (relevant if involves chemicals, frequent hand washing, etc.)

Do you smoke? (relevant to skin/nail health)

Do you bite nails / have nail habits?

Section D — Treatment Goals (completed by client)

Treatment(s) you are interested in today

Your main goals or concerns (what result are you hoping for?)

Previous similar treatments? Any reactions or concerns?

Any other information you feel is relevant?

Section E — Therapist Assessment (completed by therapist)

Skin type observed (Fitzpatrick scale or descriptor)

Skin condition/notes (tone, texture, hydration, visible concerns)

Treatment carried out (include products and techniques used)

Contraindications identified / adaptations made

Patch test required? (circle: Yes / No / Already on file)

Aftercare advice given (briefly)

Recommended follow-up / next appointment

Therapist name & initials

Section F — Consent Declaration (completed by client)

      Please read carefully before signing. This declaration confirms that you have understood and agreed to the following:
    

I confirm the information I have provided is accurate and complete to the best of my knowledge.
I understand that it is my responsibility to inform my therapist of any changes to my health, medications, or circumstances before future appointments.
I have been informed of the nature of my chosen treatment(s), including any potential risks, side-effects, and aftercare requirements, and I give my consent to proceed.
I understand that beauty therapy treatments carry a small risk of reaction or sensitivity, and that results may vary between individuals.
I consent to my therapist recording notes about today's treatment and my medical history for the purpose of providing ongoing safe treatment. These records are retained for a minimum of 5 years in accordance with our GDPR Privacy Notice.
I confirm that no photographs of me have been taken without my separate, specific consent.
I understand that I may withdraw this consent at any time by contacting [Business Name], subject to my therapist's ability to continue treating me safely.

For clients under 18: this form must be completed and signed by a parent or legal guardian, who must also be present for the treatment.

Client Signature

Signed (full name)

Date

Parent/guardian name (if client under 18)

Therapist

Signed: [Your Name]

Date

Qualifications held