Med Spa Intake Form Template: What to Collect and Why

Every med spa has an intake form. Most were assembled in a hurry before opening day: a medical history page borrowed from a previous employer, a HIPAA acknowledgment downloaded from somewhere, a cancellation policy the owner typed up, and a signature line at the bottom. It works well enough until someone outside the practice reads it closely, whether that is a medical director inheriting the practice, a carrier reviewing a claim, a board investigator, or a buyer's clinical reviewer during a sale.

At that point the form is judged on three questions. Did it collect what the practitioner needed to decide whether to treat? Did it collect the acknowledgments the practice relies on when there is a dispute about money, photographs or privacy? And does the chart show that a clinician actually read it, rather than that a patient filled it in and a treatment followed?

This guide walks through what a med spa intake form template should contain, section by section, why each item is there, and how to run the form so it stays current. It is written for a national audience. Where the answer depends on your state, and several parts do, we say so and point you to our state-by-state regulations hub rather than guessing. Nothing here is a clinical rule: the screening questions below are questions the form collects so a qualified practitioner can evaluate the answers.

Is a Med Spa Intake Form the Same as a Good Faith Exam?

No. An intake form collects information from the patient; a good faith exam is a licensed prescriber evaluating that patient and deciding whether a treatment is appropriate. Treating off an intake form, with no prescriber evaluation in between, is one of the documentation failures our state guides flag most often.

The difference is who does the thinking. On an intake form, the patient answers questions and the practice records the answers. Nobody has yet decided anything. The form can tell you that a patient takes a blood thinner, had filler in the same area eight months ago, and is trying to conceive. It cannot tell you what those facts mean for this patient and this treatment, because that judgment belongs to a clinician with the authority to make it. The exam is where that judgment happens, and its output is a patient-specific order. The intake form is an input to the exam, in the same way a lab result is an input to a diagnosis.

The failure pattern looks efficient from the inside. A patient completes a thorough online questionnaire, the answers contain no obvious red flags, a nurse or aesthetician reviews it, and treatment proceeds under a protocol. The chart looks full. What it does not contain is an entry showing that a prescriber evaluated this patient before the treatment and ordered it. A detailed form does not fill that gap. If anything, a long questionnaire with no evaluation after it makes the gap easier to see, because it shows the practice had the information and nobody with authority used it. Our good faith exam guide covers the exam itself: who may perform it, what it must contain, whether it can be done remotely, and how states treat it. This page stays on the form.

One practical consequence runs through everything below. Design the intake form so that it hands off to an evaluation rather than replacing one. The form should end with a step that routes the chart to the practitioner performing the exam, and your workflow should make it impossible to reach the treatment room from the intake form alone.

What Is a Med Spa Intake Form Actually For?

A med spa intake form has three jobs: it identifies the patient and how to reach them, it collects the health information a practitioner needs before evaluating them, and it records the patient's acknowledgment of the practice's policies. It is data collection and documentation. It is not a consent to any particular treatment and it is not a clinical decision.

Intake, consent and the exam are three different documents

Practices often merge them to shorten the paperwork, and the merge causes most of the problems we see. The intake form collects history and acknowledgments. The informed consent is the patient agreeing to a specific treatment after its risks, benefits and alternatives have been explained, and it is signed for each treatment episode it covers. The exam note is the clinician's record of the evaluation and the order that came out of it. A single form that tries to do all three usually does none of them well: the consent is too generic to name the risk that later occurred, and the "exam" is a checkbox the patient ticked. Our med spa consent forms guide covers the consent side in full.

What Demographic and Contact Details Should the Form Collect?

Collect enough to identify the patient reliably, contact them after treatment, reach someone on their behalf in an emergency, and bill them correctly. That means legal name, date of birth, contact details, an emergency contact, and a record of how the patient's identity was verified. Collect nothing you do not need, because every field you add is information you must protect.

Identity

• Legal name, plus a preferred name if the patient uses one. Charts are matched on legal name; staff should use the preferred name in conversation.
• Date of birth. It is the second identifier for matching records, and it is how the practice confirms whether a patient is a minor.
• Sex and, if your practice collects it, gender identity, recorded in a way that serves the clinical purpose. Some screening questions, such as pregnancy status, depend on it, but the form should not assume.
• Identity verification. A note that a government-issued photo ID was checked at the first visit, by whom, and on what date. Many practices keep a copy or scan. If you do, it becomes part of the record you must secure.

Contact and communication preferences

• Mailing address, mobile number and email.
• Preferred contact method, and whether the patient agrees to receive appointment reminders and post-treatment follow-up by text or email. Record this as a separate choice. Clinical follow-up after a complication is a different thing from marketing messages, and the two should not share a checkbox.
• Permission to leave a message, and at which number. A voicemail left on a shared household line is a small privacy decision the patient should make, not the practice.
• Marketing opt-in, if you ask for it at all, as a clearly separate and optional choice. Leaving it unticked should not affect anything else on the form.

Emergency contact

Ask for at least one emergency contact with a name, relationship and phone number. It matters most in the situations a med spa hopes never to have, such as a patient who faints and cannot drive home. The form should also ask whether the practice may share treatment information with the emergency contact. Being listed as an emergency contact is not the same as being authorized to receive health information, and staff should know which is which before they make the call.

What Medical History Belongs on a Med Spa Intake Form?

The medical history section should give the evaluating practitioner a complete picture: current and past conditions, every current medication and supplement, allergies, prior aesthetic treatments and any complications, and the specific screening questions your service menu makes relevant. Its job is to make sure nothing important is missed, not to decide anything.

The single most useful design choice is to make every question answerable with "yes," "no" or "not sure," with space for detail after a "yes" or "not sure." Blank answers are ambiguous: a reviewer later cannot tell whether the patient said no or skipped the question. A "not sure" option is honest and it flags the item for conversation. Every section below should also end with an open question, such as "Is there anything else about your health you think we should know?", because patients volunteer things in free text that no checklist anticipates.

Current and past medical conditions

Organize conditions by body system so the list is easy to scan and hard to skip. Typical groupings include:

• Heart and circulation: heart disease, rhythm problems, high or low blood pressure, fainting episodes, and any implanted cardiac device.
• Bleeding and clotting: easy bruising, prolonged bleeding after cuts or dental work, known clotting or bleeding disorders, and past blood clots.
• Neurological and neuromuscular: seizures, migraines, facial nerve problems, and neuromuscular conditions.
• Immune and autoimmune: autoimmune or connective tissue conditions, immunosuppression from illness or medication, and recent serious infections.
• Endocrine and metabolic: diabetes, thyroid conditions, and other hormonal conditions.
• Skin: active skin conditions in or near the treatment area, a history of cold sores, abnormal scarring, pigment changes after injury, and skin cancer history.
• Mental health: asked respectfully and optionally, including conditions the patient is being treated for. This is relevant to expectations, to medication interactions and, for some services, to the prescriber's evaluation.
• Other: kidney or liver disease, cancer history and current treatment, recent surgery or hospitalization, and anything else the patient is being treated for.

Current medications, including anticoagulants and supplements

This is the section most likely to be incomplete, because patients do not think of everything they take as a medication. Ask for every prescription medication with its dose, every over-the-counter medication taken regularly, and every vitamin, herbal product and supplement. Then ask specific follow-up questions rather than relying on the patient's list:

• Blood thinners: "Do you take any blood thinner or anti-platelet medication, including daily aspirin?" Name the category plainly and give examples in patient language. Patients who take a daily low-dose aspirin often leave it off a medication list.
• Supplements that patients rarely mention: fish oil, vitamin E, ginkgo, garlic and similar products. Many practices ask about them specifically because they are relevant to bruising and bleeding, and the practitioner may want to know.
• Retinoids, both topical and oral, including prescription acne treatments, with when they were last used.
• Antibiotics and antivirals taken recently or currently.
• Medications that affect the immune system, including steroids and biologic drugs.
• Medications that increase sun sensitivity, which the practitioner may want to know about before any light- or energy-based treatment.
• Weight-loss medications, including any GLP-1 medication obtained elsewhere, and hormone therapy of any kind.

Record the answer, not the conclusion. The form should say "patient reports daily low-dose aspirin" rather than "OK to proceed." What the aspirin means for today's treatment is the practitioner's call, made during the evaluation and recorded in the exam note.

Allergies

Ask about drug allergies, and for each one what happened: a rash, swelling, difficulty breathing, or a reaction the patient only heard about. "Allergic to penicillin" and "had anaphylaxis to penicillin" are very different entries. Then ask about the allergies that are specific to aesthetic practice: local anesthetics such as lidocaine, latex, adhesives and tape, topical numbing creams, and any prior reaction to a filler, toxin or other injectable. The form should ask whether the patient carries an epinephrine auto-injector, which is both a clue about history and something staff should know.

Prior aesthetic treatments and complications

Aesthetic history is where a generic medical history form falls short. Ask:

• Which treatments the patient has had, roughly when, and where: neurotoxin, filler, threads, laser and light treatments, chemical peels, microneedling, body contouring, surgery.
• For filler specifically, which product if known, and in which areas. Patients often do not know the product; "don't know" is a useful answer because it tells the practitioner what they do not know.
• Any permanent or semi-permanent filler or implant, including in the face, lips or body.
• Any complication, bad reaction or result the patient was unhappy with, and how it was managed. A history of a vascular event, a delayed nodule, prolonged swelling, a burn or pigment change is exactly the kind of fact the practitioner needs before deciding.
• Cosmetic surgery in or near the treatment area.
• Whether the patient is currently under the care of another aesthetic practice for the same concern.

Screening questions practices commonly ask

Beyond the general history, most practices add targeted screening questions tied to the services they offer. The questions below are ones practices commonly include. They are not a list of contraindications, and a "yes" to any of them does not by itself mean a patient cannot be treated. Each is on the form so the practitioner can decide what it means for this patient and this treatment. The final list should be set by your medical director and should follow the instructions for use of the products and devices you actually use.

Screening question	Why practitioners commonly want to know
Are you pregnant, trying to become pregnant, or breastfeeding?	Many product labels and practice protocols address pregnancy and breastfeeding. The answer should be current on the day of treatment, not just at the first visit.
Do you have an autoimmune or connective tissue condition?	Practitioners often consider immune status when evaluating injectables, energy devices and wound healing.
Have you ever formed a keloid or raised, thickened scar?	Scarring history is relevant to any treatment that injures the skin on purpose, such as resurfacing, microneedling and some peels.
Have you taken isotretinoin, and if so, when did you stop?	Recent use is something many practitioners ask about before resurfacing and other skin-injuring treatments. Record the date as precisely as the patient can give it.
Do you get cold sores?	Relevant before treatments around the mouth and before resurfacing; the practitioner decides whether anything should be done about it.
Do you bruise or bleed easily?	Complements the medication questions; patients sometimes report a tendency they have never had diagnosed.
Do you have a pacemaker, defibrillator or other implanted electronic device, or metal in the treatment area?	Device manufacturers' instructions for use commonly address implants, which matters for energy-based treatments.
Have you had recent sun exposure, tanning or self-tanner?	Relevant to laser, light and resurfacing treatments.
Do you have a neuromuscular condition?	A question practitioners commonly consider before neurotoxin treatment.
Do you have an active infection or skin condition in the treatment area?	Practitioners generally want to examine the area before any treatment through the skin.

Notice what the right-hand column does not say. It does not say "do not treat." It says why the question is there. That is the right posture for an intake form, and it is the right posture for staff who read it. The exam note is where the practitioner records what the answer meant.

Should a Med Spa Use One Intake Form or One Per Service Line?

Use one core intake form for every patient plus a short, service-specific module for each service line. The core form collects identity, history, medications, allergies and acknowledgments once; the modules add the questions only some treatments need. One universal form either misses questions or makes every patient answer dozens that do not apply to them.

A patient booking neurotoxin should not have to answer questions about their pacemaker and tanning habits; a patient booking laser hair removal should. When every patient answers every question, answers get less careful.

Typical modules

• Injectables: prior injectable history in detail, product reactions, recent dental work or planned dental work, upcoming events and travel, and prior complications.
• Laser, light and energy devices: skin reaction to sun, recent sun exposure and tanning, photosensitizing medications, implants and devices, tattoos or permanent makeup in the treatment area, and prior energy-device treatments.
• Chemical peels, microneedling and resurfacing: scarring and pigment history, retinoid and isotretinoin history, cold sore history, and current skin care products.
• Medical weight loss: weight history, prior weight-loss treatments, gastrointestinal history, personal and family thyroid history, pancreatic and gallbladder history, and pregnancy plans. This module feeds a prescriber's evaluation, and our GLP-1 weight loss compliance guide covers what that evaluation involves.
• IV therapy: kidney, heart and fluid-balance history, prior IV reactions, and current medications in detail.
• Hormone therapy: the hormone history your prescriber asks for, with prior testing and current hormone use from any source.
• Body contouring: hernia history, implants in the treatment area, and conditions your device's instructions address.

Each module should be approved by the medical director and versioned in the same way as the core form, which the version-control section below covers.

What Should the Intake Form Ask About Treatment Goals?

Ask what the patient wants to change, why now, and what result they expect, in their own words. Goals give the practitioner the context to recommend, modify or decline a treatment, and a recorded expectation is the best evidence you have if the patient later says the result was not what they were promised.

A few additional questions tend to earn their place:

• Timing. Is there an event, a trip or a photograph coming up? It affects scheduling, and it helps the practitioner explain recovery time and the chance of bruising in advance.
• Previous results. What did the patient like or dislike about any previous treatment? This often tells you more about expectations than any other question.
• Budget and commitment. Some treatments need a series or maintenance. Asking early avoids a plan the patient will not complete.
• Concerns. What worries the patient about treatment? Fear of needles, of looking "done," or of a specific complication is worth knowing before the consultation begins.

Some practitioners also consider whether a patient's concern about their appearance is out of proportion to what they see on examination, and some use a structured screening questionnaire for that purpose. Whether to do so, and what to do with the result, is a clinical decision for your medical director, not something the intake form should decide.

Which Acknowledgments Belong in the Intake Packet?

The intake packet should record the patient's acknowledgment of your privacy notice, your photography practices, your financial policy and your cancellation policy. Each acknowledgment should be separate, specific and dated, because each may be needed as evidence on its own, and a single signature under a page of mixed policies proves very little.

HIPAA Notice of Privacy Practices acknowledgment

If your practice is a HIPAA covered entity, the Privacy Rule requires you to give new patients your Notice of Privacy Practices and to make a good-faith effort to obtain their written acknowledgment that they received it. If the patient declines to sign, record that you tried and why it did not happen. The acknowledgment is a receipt, not a consent: it confirms the patient was given the notice, and it does not authorize any use of their information beyond what the Privacy Rule already permits.

Whether your practice is a covered entity depends on whether it transmits health information electronically in connection with a standard transaction, such as an insurance claim or eligibility check. Many practices that start out cash-only take on insurance-related services later without noticing that the status may have changed, and state privacy laws can apply regardless of HIPAA status. Our HIPAA compliance guide for med spas covers the notice itself and the rest of the documentation set.

Photography: a reference, not a blanket release

Clinical photographs taken to document a treatment are part of the medical record. Using those photographs for marketing is a different use, and it needs its own authorization that the patient is free to refuse. The intake packet should do two things. It should tell the patient that clinical photographs are taken as part of treatment and kept in the record, and it should refer to a separate, optional marketing authorization rather than burying marketing permission in the intake signature.

The mistake is a single line in the intake form saying the practice may use photographs "for educational and promotional purposes." A patient who later objects will say, reasonably, that they signed a stack of forms to get treated and never agreed to appear on your social media. Our guide to testimonial and marketing consent explains why marketing permission should not be bundled into intake paperwork and what the separate authorization needs to say.

Financial policy acknowledgment

A financial policy tells the patient how and when they pay, what happens to prepaid packages and memberships, how deposits work, how refunds are handled, and whether aesthetic treatments are covered by insurance (almost always not). The acknowledgment should reference the specific version of the policy the patient saw. A patient disputing a charge will ask what they agreed to, and "our standard policy" is not an answer if the policy changed twice since they signed.

Cancellation and no-show policy acknowledgment

State the notice period, the fee or deposit forfeiture, how late arrivals are handled, and any exceptions. Ask the patient to acknowledge it separately from the financial policy, because it is the policy most often disputed and the one most often applied to a patient who is already unhappy. If you store a card to enforce the policy, say so on the form, and make sure your payment processor's rules and any state consumer-protection rules on stored-card charges are reflected in the wording.

Consent to treat versus procedure consent

Many intake packets include a general consent to evaluation and routine care. That is reasonable, but it is not informed consent to any specific procedure. Procedure-specific consent is a separate document, signed for the treatment it covers, after the practitioner has explained that treatment. An intake packet that says "I consent to any treatment my provider recommends" gives the practice a false sense of security and gives the patient's lawyer an easy argument.

Can Med Spa Intake Forms Be Completed and Signed Electronically?

Generally yes. Federal and state electronic-signature laws broadly give electronic signatures and records the same legal effect as paper, and most practices now send intake forms through a patient portal or link before the appointment. What matters is not the medium but whether the record can later prove who signed, what they signed, and when.

Digital intake lets patients answer at home without being rushed, prevents skipped fields, and records which form version each patient saw. There are exceptions and edge cases in electronic-signature law, and the requirements for particular documents can differ by state, so confirm with counsel before relying on electronic signatures for anything unusual.

What a defensible electronic signature record captures

• Identity: how the signer was identified, such as a unique link sent to the patient's own email or phone, and the identity check performed at the first visit.
• Time: a date and time stamp for completion and for each signature, not just for the upload.
• Content: a locked copy of exactly what the patient saw and answered, including the form version number.
• Intent: a clear action showing the patient meant to sign, such as typing their name or drawing a signature next to an attestation.
• An audit trail: who opened, edited or reviewed the record afterward, and when.
• Security: the platform should be one your practice has assessed for handling health information, with a business associate agreement in place where HIPAA applies.

How Should a Med Spa Version-Control Its Intake Forms?

Treat the intake form like any other controlled document: give it a version number and effective date, have the medical director approve each version, keep every retired version, and make sure the chart shows which version each patient completed. Without version control, the practice cannot prove what a patient was asked or what they acknowledged on a given date.

Suppose a patient treated in March says nobody asked about their blood thinner. The form was edited in June to add that question, and nobody kept the March version. Now the practice cannot show what the patient was actually asked.

The minimum version-control record

• A document number and version, printed on every page of the form and every module.
• An effective date, and the date the previous version was retired.
• An approval block with the medical director's name, credential, signature and date for the clinical sections, and the owner's or practice manager's approval for administrative sections.
• A change log stating what changed and why, in a sentence or two per change.
• An archive of every prior version, kept at least as long as the charts that reference it.
• A link from the chart to the version, which digital systems usually handle automatically and paper workflows handle by the version number printed on the form.

When to revise the form

Review the intake form at least annually as part of your wider document review, and revise it whenever one of these happens: you add a service, product or device; your medical director changes a protocol in a way that needs a new screening question; an adverse event or near miss shows the form missed something; your state changes a rule that affects intake; or you change your financial, cancellation or photography policies. Each revision should be approved, dated and logged before it goes live. Our policy and procedure manual guide covers document control across the whole manual.

Do Patients Need to Update Their Intake Form at Every Visit?

Patients do not need to redo the whole form at every visit, but the practice should confirm and document at every visit whether anything has changed. The usual approach is a short interval update at each appointment, a full re-intake on a fixed cycle, and a full re-intake whenever the patient reports a significant change.

The information that matters most changes between visits. A patient who was not pregnant in January may be in April, or may have started a blood thinner or had filler elsewhere since you last saw them.

The interval update

At each visit, before the practitioner sees the patient, ask a short set of questions and record the answers:

• Any new medical conditions, diagnoses or hospital visits since your last appointment?
• Any new medications or supplements, or changes to doses, including blood thinners, retinoids and antibiotics?
• Any new allergies or reactions?
• Any aesthetic treatments elsewhere since your last visit?
• Are you pregnant, trying to become pregnant, or breastfeeding?
• Any problems after your last treatment with us?
• Has your contact information or emergency contact changed?

Record the answers and have the patient confirm them with a signature or electronic attestation. "No changes" is a valid answer, but it should be the patient's statement, dated and signed, not an assumption carried forward by staff. A chart where every follow-up visit shows the same copied history is a chart where nobody asked.

The full re-intake

Many practices ask every active patient to complete the full intake again on a fixed cycle, commonly once a year, and whenever the patient reports a significant change such as a new diagnosis, pregnancy or a major medication change. It is also sensible to require a full re-intake when a patient returns after a long gap, and when the form itself has been significantly revised so that returning patients answer the new questions.

Updating the intake is not the same as repeating the evaluation. Whether a change in the patient's history means the practitioner should evaluate them again before the next treatment is a clinical and, in some states, legal question. The good faith exam guide discusses when a new evaluation is needed. The intake update is what tells the practitioner something has changed.

Who Should Review the Intake Form Before Treatment?

Two reviews, by two different people. Front desk or intake staff check the form is complete, current and signed. The practitioner performing the evaluation reviews the health information and records that review in the chart before anything is ordered or performed. Staff who are not licensed to evaluate should collect and route information, not interpret it.

The completeness check is administrative. Is every question answered? Is every "yes" followed by the detail the form asks for? Is it signed and dated? Is it the current version? Are all the required acknowledgments present? Anything missing is resolved with the patient before the appointment moves forward.

The clinical review is the practitioner's. It should be visible in the chart as an entry made by that practitioner, at a time before the treatment, referring to the intake. A good pattern is for the exam note to say what in the intake mattered: "Reviewed intake v3.2 dated [date]. Daily aspirin noted; discussed bruising risk. Prior filler, product unknown, in lips 2024." That line proves the form was read, and it proves the reading happened before the treatment.

Flags and escalation

Build a flag into the workflow. When a patient answers "yes" or "not sure" to a question the medical director has designated as significant, the chart should be marked for the practitioner's attention before the patient is roomed. Staff should know what to say: "The practitioner will go over that with you before we go ahead." They should not tell the patient they can or cannot be treated.

The same applies when a patient mentions a new medication in the treatment chair: the procedure pauses until the practitioner has considered it, and the chart records that they did. Our guide to standing orders and protocols covers how those documents relate to a patient-specific order.

How Do Intake Requirements Differ From State to State?

The core content of a good intake form is the same everywhere, but several of the rules around it are set by each state: who may consent for a minor and which treatments minors may receive, whether the evaluation can happen by telehealth and how an asynchronous intake is treated, how long records must be kept, and what state privacy law adds on top of HIPAA. A national template needs a state review before you rely on it.

Minors

The age at which a patient may consent on their own, what a parent or guardian must sign, whether the guardian must be present, and whether particular cosmetic treatments may be offered to minors at all are questions of state law, and the answers differ. Your intake form should at least identify minors by date of birth, trigger a separate guardian workflow, record the guardian's identity and relationship to the patient, and capture the minor's own agreement where appropriate. Our consent forms guide covers minor consent documents, and your state's rules should decide the rest.

Telehealth and asynchronous intake

Many practices now collect intake online and have the evaluation done by a remote prescriber. Whether and how that is permitted is set state by state, and a remote evaluation generally has to meet the same standard as an in-person one. The specific trap for intake is the asynchronous model where the form itself effectively approves the patient: the patient answers questions, the answers contain no red flags, and a prescription or order issues without a clinician actually evaluating that patient. That is intake standing in for an exam, just with more technology. Our telehealth prescribing guide covers the state-by-state picture.

Record retention

Intake forms are part of the medical record, so they are kept for as long as your state requires medical records to be kept, and often longer for minors. Retention periods differ by state and by the type of practitioner who owns the record. Our medical records retention guide covers the details. Retired form versions should be kept at least as long as the charts that reference them.

What a Med Spa Intake Form Template Must Include

A complete med spa intake form template includes identity and contact details, an emergency contact, a full medical history with medications, supplements and allergies, aesthetic history, service-specific screening questions, treatment goals, separate acknowledgments for privacy, photography, finances and cancellations, a signature block, and version control. Use the checklist below to audit your current form.

Patient identity and contact

• Legal name, preferred name, date of birth
• Identity verification record (ID checked, by whom, date)
• Address, mobile number, email
• Preferred contact method and permission to leave messages
• Separate consent for clinical text and email communication
• Separate, optional marketing opt-in
• Emergency contact: name, relationship, phone, and whether health information may be shared with them
• Primary care clinician and relevant specialists, with permission to contact

Medical history

• Conditions by body system, answered yes / no / not sure, with detail for each yes
• All prescription medications with dose
• Over-the-counter medications taken regularly
• Vitamins, herbal products and supplements
• Specific questions on blood thinners and anti-platelet medication, including daily aspirin
• Specific questions on retinoids, isotretinoin, antibiotics, antivirals, immune-affecting drugs and sun-sensitizing medications
• Drug allergies with the reaction for each
• Allergies to local anesthetics, latex, adhesives and prior injectables
• Epinephrine auto-injector use
• Pregnancy, plans to conceive, and breastfeeding status
• An open "anything else" question

Aesthetic history and screening

• Prior aesthetic treatments by type, approximate date and location
• Filler products and areas, if known; permanent fillers and implants
• Prior complications and how they were managed
• Cosmetic surgery in or near the treatment area
• Screening questions set by your medical director for each service line (autoimmune conditions, keloid and scarring history, isotretinoin, cold sores, implants and devices, sun exposure and others relevant to your menu)
• Service-specific modules for injectables, energy devices, resurfacing, weight loss, IV therapy, hormones and body contouring as applicable

Goals and expectations

• What the patient wants to change, in their own words
• What a good result would look like to them
• Upcoming events and timing constraints
• Experience with previous treatments
• Concerns about treatment

Acknowledgments

• Receipt of the Notice of Privacy Practices, with a record of the effort if the patient declines to sign
• Notice that clinical photographs are taken and kept in the record
• Reference to a separate, optional marketing photo authorization
• Financial policy acknowledgment, citing the policy version
• Cancellation and no-show policy acknowledgment, citing the policy version
• General consent to evaluation, clearly distinguished from procedure-specific consent

Signature, review and control

• Patient attestation that the information is complete and accurate
• Patient signature and date, or a guardian's with the relationship recorded
• Electronic signature audit trail where signed digitally
• Staff completeness check with name and date
• Practitioner review recorded in the chart before treatment
• Document number, version, effective date and medical director approval on every page
• Interval update at every visit, and full re-intake on a set schedule

What Are the Most Common Med Spa Intake Form Mistakes?

The most damaging intake mistakes are the ones that let a form stand in for a clinical decision or leave the practice unable to prove what a patient was asked. The rest are gaps in content: missing medication questions, stale histories, bundled permissions and uncontrolled versions. Almost all of them are cheap to fix once you know to look.

1. The form is the only clinical step. The patient completes the intake, nobody with prescribing authority evaluates them, and treatment follows. This is the mistake that matters most, for the reasons set out at the top of this guide.
2. Staff interpret the answers. A receptionist or aesthetician decides that a "yes" does not matter. Even when they are right, the chart now shows an unlicensed clinical judgment.
3. No record that the practitioner read it. The form is in the chart, but nothing shows who reviewed it or when, so it cannot be shown to have informed the evaluation.
4. Blank answers. Questions left empty instead of answered "no" are ambiguous, and they tend to be the questions that later matter.
5. A medication list that relies on memory. No specific questions about blood thinners, aspirin, supplements, retinoids or recent antibiotics, so the list reflects only what the patient happened to think of.
6. A history that never updates. The intake from the first visit is carried forward for years without anyone asking whether anything changed.
7. Marketing permission bundled into the intake signature. A line allowing promotional use of photographs, signed along with everything else, gives the practice little it can rely on.
8. "I consent to any recommended treatment." A general consent in the intake packet is treated as procedure consent, and no treatment-specific consent is signed.
9. No version control. The form changes and nobody can show which version a patient saw.

A useful self-audit is to pull ten recent charts and, for each, answer four questions: is the intake complete and on the current version, was it updated at this visit, does the chart show the practitioner reviewed it before treatment, and is the procedure consent a separate document? Our Botox charting template guide describes how to turn that into a regular chart audit, and our inspection guide covers what reviewers tend to ask for.

Should You Use an Intake Form Template or Build Your Own?

Start from a template and make it yours. A good template saves you from forgetting whole sections, but no template knows your service menu, your devices, your medical director's screening preferences or your state's rules. What has to be your own is the localization, the approval and the process around the form.

What a template cannot do is make the form fit your practice. Before you put any template into service:

• Add or remove service modules to match what you actually offer.
• Have your medical director set the screening questions for each service line and approve the clinical sections.
• Align the questions with the instructions for use of the products and devices you use.
• Insert your own financial, cancellation and photography policies, and version them.
• Have a healthcare attorney licensed in your state review the minor, telehealth, privacy and retention elements.
• Write down the process around the form: who sends it, who checks it, who reviews it, how flags are escalated, and how it is updated at each visit.

The last point is the one most often skipped, and it is the one that decides whether the form works. A well-designed form with no process around it gets completed, filed and never read. A modest form with a clear review step, a flag for significant answers and an interval update at every visit does its job. The form is the document; the intake SOP is what makes it matter. Our guide to med spa standard operating procedures shows where the intake SOP sits in the full document library.

Disclaimer: The information provided by MedSpa Standards is for educational purposes only and does not constitute legal, medical, or professional advice. Regulations vary by state and change frequently. All documents should be reviewed and customized by your Medical Director and legal counsel to ensure compliance with applicable state and federal regulations.

Published: September 26, 2026 | Category: Compliance Guides | Tags: med spa intake form, patient intake form template, aesthetic intake form, medical history form, med spa compliance