Q01
Message
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Facial Treatment Client Intake & Skin Consultation
A pre-appointment intake for estheticians, spas, and skincare clinics that captures skin type, primary concerns, safety-relevant history (retinoids, recent peels, allergies), and treatment goals — with an AI follow-up that digs into the story behind the client's main concern so the esthetician walks in prepared, not guessing.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
14 questions · ~7 min
Q02
Multiple ChoiceRequired
How would you describe your skin type most days?
- Oily
- Dry
- Combination
- Normal
- Sensitive/reactive
- Not sure
Q03
Multiple ChoiceRequired
Which skin concerns would you most like this appointment to address? Select all that apply.
- Acne or breakouts
- Fine lines and wrinkles
- Uneven tone or dark spots
- Redness or rosacea
- Dullness or lack of glow
- Rough texture or clogged pores
- Dehydration or tightness
- Large pores
Q04
Rating ScaleRequired
How severe would you say your main concern is right now?
Range: 1 – 5
Min:Barely noticeableMax:Very severe
Q05
Long Text
Walk us through your current skincare routine (products, frequency, and any active ingredients like retinol, vitamin C, or exfoliating acids).
Q06
Multiple ChoiceRequired
Have any of the following applied to you in the last 2 weeks? This helps us avoid treatments that could irritate your skin.
- Used prescription retinoids (e.g., tretinoin)
- Taken Accutane/isotretinoin in the last 6 months
- Had a chemical peel, microneedling, or laser treatment
- Had Botox or filler injections
- Been in the sun without protection for an extended period
- Had a cold sore or active skin infection
Q07
Long Text
Do you have any known allergies or sensitivities to skincare ingredients, fragrances, or essential oils we should know about?
Q08
Opinion ScaleRequired
Overall, how satisfied are you with the current state of your skin?
Scale: 1 – 7
Min:Very dissatisfiedMax:Very satisfied
Q09
RankingRequired
Rank these outcomes in order of what you'd most like to get out of today's facial.
- Clearer, less congested skin
- Reduced fine lines or firmness
- Even, brighter tone
- Deep hydration
- Calmer, less reactive skin
- A relaxing self-care experience
Drag to rank
Q10
AI Interview
Explore the story behind the client's top-ranked concern: when it started, what they've already tried, and what a 'successful' facial would look or feel like to them. If they flagged any recent treatment, medication, or allergy in the safety screening, confirm the specific product/timeframe and ask if they've had a reaction to facials before. Keep the tone warm and non-clinical, like a trusted esthetician asking follow-up questions before service.
Q11
Consent
Before/after photo consent
Q12
Multiple Choice
What's your age range?
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q13
Multiple Choice
How would you describe your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q14
Message
Thank you for sharing all of this! Your answers go straight to your esthetician so they can personalize today's facial and steer clear of anything that might irritate your skin.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Goes beyond static fields by using an AI follow-up interview that explores the story behind the client's top-ranked concern (onset, triggers, what's been tried) so the esthetician isn't guessing.
- Captures safety-relevant history in the same flow — recent peels/retinoid use, allergies and sensitivities — alongside skin type, concerns, and a severity rating.
- Uses a ranking question to force clarity on which outcome matters most, then feeds that directly into the AI probe, rather than leaving multiple selected concerns equally weighted.
- Includes built-in consent handling for before/after photos and closes with a clear hand-off message, so the whole intake-to-esthetician pipeline is transparent to the client.
Jotform
Facial Treatment Client Intake Form TemplateA dedicated, fielding-ready facial intake form covering standard skin history and concern fields. It's a static form builder template, well-suited for basic paperwork replacement but not designed to probe further into a client's answers. Good for spas wanting a quick, customizable form rather than deeper client insight.
What it does well
- Purpose-built for facial/esthetician intake, so field language matches the use case
- Jotform's drag-and-drop builder allows easy customization of fields
- Likely supports e-signature/consent-style fields common to intake forms
Where it falls short
- Static question set with no adaptive follow-up into the client's specific concern
- No automated quality scoring of open-ended responses
- No voice-based interview option for clients who prefer speaking over typing
SurveySparrow
Free Facial Client Intake Form Template | PrintableA conversational-style facial intake template, explicitly offered free and printable, aimed at spas collecting basic client info before treatment. It leans toward a friendlier chat-like UI for form-filling but remains a fixed question sequence rather than an interview. Reasonable for simple pre-appointment paperwork.
What it does well
- Facial-specific template with a conversational UI style
- Offered free and explicitly printable, useful for paper-based intake at the front desk
- Likely simple to deploy without extensive setup
Where it falls short
- No adaptive AI questioning to dig into the story behind a client's main concern
- No transparent methodology or published prompt logic since there's no AI interview layer
- No automated per-response quality scoring of intake answers
Typeform
Facial Intake Form TemplateA polished, conversational one-question-at-a-time facial intake template, matching Typeform's known strength in form UX. It's a fixed-flow template, not an adaptive interview, so it collects the same set of answers regardless of what a client discloses. Solid for a clean-feeling client-facing form.
What it does well
- Facial-specific template with strong, well-known form design/UX
- One-question-at-a-time flow reduces client fatigue
- Easy to embed on a spa's booking or website flow
Where it falls short
- No adaptive AI follow-up interview to explore the story behind stated concerns
- No voice AI interview option
- No automated scoring or auto-generated report summarizing client readiness for the esthetician
SurveyMonkey
Client Intake Form TemplateThis is a generic client intake template, not specific to facials or skincare, so it likely needs significant editing to cover skin type, retinoid/peel history, and allergy fields relevant to esthetician appointments. It's a fielding-ready survey template but for general service-business intake rather than this niche.
What it does well
- Backed by SurveyMonkey's general survey infrastructure and familiar builder
- Broad template structure adaptable to many client-facing businesses
- Straightforward to launch as a basic questionnaire
Where it falls short
- Not tailored to facial/skincare specifics like retinoid use, peels, or skin type out of the box
- No adaptive AI interview or voice AI option to explore a client's concern in depth
- No automated per-response quality scoring or auto-generated report for the esthetician
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.