Beautay

Client consultation consent form

Add your clinic details and print a consultation and medical history form. Use it at a first appointment to record the information you need before deciding whether treatment is appropriate.

Your clinic details

These appear at the top of the form. Nothing is sent anywhere, it all stays in your browser.

Your professional registration number if you have one.

Choose Save as PDF in the print dialog if you want a file rather than paper.

Your clinic name

Consent to treatment

Client Consultation and Medical History

Client details

Full name
Date of birth
Address
Contact number
Email address
GP name and practice
How did you hear about us?

What you would like to achieve

Describe in your own words what is bothering you and what you would like treatment to change. There is no right answer and it helps your practitioner understand whether the treatment you have in mind is the right one.

Medical history

Please indicate whether any of the following apply to you, now or in the past.

  • Heart or circulatory condition
  • High or low blood pressure
  • Diabetes
  • Epilepsy or seizures
  • Neurological or neuromuscular condition
  • Autoimmune condition
  • Cancer, current or previous
  • Bleeding or clotting disorder
  • Hepatitis, HIV or other blood borne infection
  • Kidney or liver condition
  • Thyroid condition
  • Recurrent cold sores
  • Keloid or hypertrophic scarring
  • Recent or planned dental treatment
  • Pregnant, breastfeeding or trying to conceive

Medicines and supplements

List everything you take, including prescription medicines, over the counter medicines, herbal remedies and supplements. Blood thinners, fish oil, vitamin E and St John's wort all matter for aesthetic treatment.

Allergies

List all known allergies, including to medicines, latex, local anaesthetic, plasters and foods. Describe what happens when you are exposed.

Previous aesthetic treatment

List any previous aesthetic treatment, including what was done, roughly when, where you had it and whether you had any problems afterwards. Include treatments carried out elsewhere.

Lifestyle

  • Do you smoke or vape?
  • How much alcohol do you drink in a typical week?
  • Do you use sunbeds or spend long periods in the sun?
  • What is your current skincare routine?

Practitioner assessment

This section is completed by the practitioner. Record your clinical observations, the treatment plan discussed, any alternatives offered, and the reason if treatment is declined or deferred.

Declaration

Please initial each statement.

  • The information I have given is accurate and complete to the best of my knowledge.
  • I will tell the clinic if any of my medical details, medicines or allergies change before my next appointment.
  • I understand that withholding information could put my safety at risk.
  • I understand that this form becomes part of my clinical record and will be stored securely.

Client

Signature
Print name
Date

Practitioner

Signature
Print name
Date

Good practice

Getting consent right

  • Update the medical history at every appointment. Take a fresh signature rather than assuming nothing has changed.
  • Record the reason if you decline to treat someone. It protects you and it helps if they return later.
  • Keep consultation records for the period your indemnity provider requires, which is often longer than you expect.
  • A consultation is a clinical assessment, not a sales appointment. Document what you advised, including any alternatives.

Important

This template is a starting point, not legal or clinical advice. Review the wording with your insurer or indemnity provider and adapt it to your own practice, products and protocols before you use it with clients.

Other templates

Stop printing consent forms

Beautay sends the right form when the appointment is booked, stores the signed copy against the client record, and prompts you to re-consent at the next visit.

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