Q01
Message
All templatesIndustry-Specific
Esthetician Client Skin Intake & History Survey
A pre-appointment intake for estheticians and skincare studios that captures skin type, concerns, allergies, contraindications, and treatment goals before a first visit — with an AI follow-up that digs into any past reactions or unclear answers so the esthetician walks in fully briefed instead of re-asking basics on the table.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Multiple ChoiceRequired
How would you describe your skin type?
- Oily
- Dry
- Combination
- Normal
- Sensitive
- Not sure
Q03
Multiple ChoiceRequired
What skin concerns would you like addressed? Select all that apply.
- Acne or breakouts
- Fine lines or wrinkles
- Hyperpigmentation or dark spots
- Redness or rosacea
- Dullness or uneven texture
- Enlarged pores
- Dehydration or dryness
Q04
Multiple ChoiceRequired
Do you have any known allergies or sensitivities to skincare ingredients (e.g., fragrance, essential oils, retinoids, latex)? Select all that apply.
- Fragrance or essential oils
- Latex
- Retinoids (e.g., Retin-A, retinol)
- Chemical exfoliants (AHA/BHA)
- Certain metals or adhesives
Q05
Long TextRequired
List any prescription skincare, oral medications, or recent procedures that could affect your treatment (e.g., Accutane, Retin-A, chemical peels, blood thinners, recent Botox or filler).
Q06
Multiple ChoiceRequired
Are you currently pregnant, nursing, or managing any skin condition (e.g., eczema, active infection) your esthetician should know about before treatment?
- Yes
- No
- Prefer not to say
Q07
Multiple Choice
Which professional skincare treatments have you had in the last 12 months? Select all that apply.
- Chemical peel
- Microdermabrasion or dermaplaning
- Laser or light therapy
- Injectables (Botox or filler)
- Facial extractions
Q08
Opinion ScaleRequired
In the last 30 days, how often did you wear sunscreen on days you were outside for more than 7 minutes?
Scale: 1 – 5
Min:NeverMax:Every day
Q09
Best–Worst Trade-off (MaxDiff)Required
When it comes to your skin, which goals matter most to you right now?
- Reduce acne or breakouts
- Minimize fine lines and wrinkles
- Even out skin tone
- Calm redness or sensitivity
- Improve hydration
- Refine pore appearance
- Achieve an overall healthy glow
Pick best & worst per setBest:Most important to meWorst:Least important to me
Q10
AI Interview
Probe the respondent's most important skin goal and any allergy, medication, or condition they flagged: ask what specifically triggered past reactions or breakouts, how their skin responded to their most recent professional treatment, and what 'success' would look like for them after a series of appointments. If they said 'not sure' about skin type or left history vague, ask concrete questions (how their skin feels by midday, whether it changes seasonally) to pin it down before treatment.
Q11
ConsentRequired
Before/after photo consent
Q12
Multiple Choice
What is your age range?
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q13
Message
Thank you for sharing your skin history with us! Your esthetician will review this before your appointment so your first session can start with a treatment plan, not a questionnaire.
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
- Captures skin type, concerns, allergies, contraindications, recent procedures, and treatment goals in one structured intake before the appointment
- Includes an AI follow-up interview that probes the respondent's top skin goal and digs deeper into any flagged allergy, medication, or reaction detail instead of leaving it as a vague text answer
- Uses a max-diff exercise to force-rank what the client actually cares about most, plus a dedicated before/after photo consent step and pregnancy/skin-condition screening question
- Ends with a clear, friendly close so the esthetician walks into the first appointment already briefed instead of re-asking basics on the table
Jotform
Esthetician Client Intake Form TemplateA static, fielding-ready intake form template specifically built for estheticians, likely covering skin type, concerns, and basic history fields. It sits inside Jotform's large form-builder library with standard drag-and-drop customization. There's no indication of any adaptive follow-up beyond fixed form logic.
What it does well
- Purpose-built for the esthetician audience
- Backed by a mature, widely-used form builder with easy customization
- Likely supports e-signature/consent-style fields common to intake forms
Where it falls short
- No adaptive AI follow-up to probe unclear allergy or reaction answers — respondents just fill fixed fields
- No automated per-response quality scoring or AI-generated debrief report for the esthetician
- No transparent, published interview-prompt methodology since it's a static form, not an interview
SurveySparrow
Free Esthetician Client Intake Form Template | Consultation FormsA free, conversational-style intake template positioned under SurveySparrow's healthcare consultation forms category, aimed at capturing client skin history in a chat-like UI. It's a ready-to-field template rather than an adaptive interview. Being free is a plus, but depth of follow-up is limited to whatever branching logic is manually built in.
What it does well
- Conversational one-question-at-a-time format that may feel friendlier than a plain form
- Free to use, lowering the barrier for small studios
- Positioned within a healthcare/consultation template category, suggesting relevant field coverage
Where it falls short
- No AI-driven follow-up that adapts to a specific allergy or reaction mentioned — only pre-set branching, if any
- No automated quality scoring of responses or auto-generated summary report
- No voice AI interview option for clients who prefer speaking over typing
Typeform
Esthetician Client Intake Form TemplateA polished, conversational one-question-per-screen template tailored to estheticians, well suited to a clean client-facing intake experience. It's a static template that relies on Typeform's standard logic jumps rather than true adaptive AI. Good for first-visit basics but not for probing follow-up on flagged concerns.
What it does well
- Clean, mobile-friendly conversational UI well matched to client-facing intake
- Esthetician-specific template, so field set should already match the use case
- Established logic-jump features for basic conditional branching
Where it falls short
- No AI follow-up interview capable of digging into vague or concerning answers in real time
- No per-response quality scoring or automated report generation for the esthetician
- No transparent published prompt/methodology since there is no AI interviewing layer
SurveyMonkey
Client Intake Form TemplateThis is a generic client intake form template, not one built specifically for estheticians or skincare history, so it would need meaningful customization to cover skin type, allergies, or contraindications. It's a static, fielding-ready form from a broad survey platform rather than a niche or adaptive tool. Useful as a generic starting point but not purpose-built for this audience.
What it does well
- Backed by a well-known, broadly capable survey platform
- Easy to customize generic intake fields for many industries
- Straightforward reporting/analytics on standard question types
Where it falls short
- Not esthetician- or skincare-specific out of the box, unlike a purpose-built skin intake template
- No adaptive AI follow-up to probe allergy, medication, or reaction details
- No automated quality scoring or AI-generated summary report for the practitioner
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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