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Aesthetic Complication Reporting Form

An aesthetic complication reporting template — let clients report and you triage post-treatment complications, with photos and urgency.

Description

When something isn’t right after a treatment, a client needs a fast, clear way to tell you — and you need enough detail to triage it. This aesthetic complication reporting form captures a post-treatment concern so you can respond quickly and appropriately.

It takes the client’s name and best contact number, which treatment it was and the date, and what they’re experiencing, with space to describe what’s happening and when it started. It lets them add a photo of the area and flag whether it’s urgent or getting worse.

Use it to give clients a direct channel for concerns and to keep a clear record of every report. Fast, documented triage protects the client and your practice. Customize the fields, add your branding, and embed it on your site or share a link in minutes.

Form fields

Everything the Aesthetic Complication Reporting Form above collects — 9 fields, so you can see exactly what it captures before you make it your own.

Report a Concern

  • Your name

    Name Icon
    Name
  • Best contact number

    Telephone Icon
    Telephone
  • Which treatment was it?

    Dropdown Icon
    Dropdown
  • Date of treatment

    Date Icon
    Date
  • What are you experiencing?

    Multi-Select Icon
    Multi-Select
  • Describe what's happening and when it started

    Long Answer Icon
    Long Answer
  • Add a photo of the area

    Upload Icon
    Upload
  • Is this urgent / getting worse?

    Yes/No Icon
    Yes/No
  • Contact

    Consent Icon
    Consent
Use Template Arrow Right Icon

Template FAQs

Common questions about the Aesthetic Complication Reporting Form — what it captures, when to use it, and how to make it your own.

What is an aesthetic complication reporting form?

An aesthetic complication reporting form gives clients a structured way to report a problem after a treatment — what they’re experiencing, when it started, and how urgent it is. It lets a practitioner triage the concern quickly and keep a clear record of it.

What should a complication reporting form include?

This form captures the client’s name and best contact number, which treatment it was and the date, what they’re experiencing, a description of what’s happening and when it started, a photo of the area, and whether it’s urgent or getting worse.

When should a client report a complication?

As soon as they notice anything unexpected after a treatment — swelling, pain, discoloration or a change that worries them. The form asks whether it’s urgent, so genuinely serious issues can be flagged and escalated rather than waiting for a routine reply.

Who uses an aesthetic complication reporting form?

Clients reporting a concern after an injectable or aesthetic treatment. The form captures their contact details and a photo, so the practitioner can assess the situation, respond quickly, and decide whether it needs a call, a review or urgent care.

Why capture a photo and urgency in a complication report?

Because a photo lets the practitioner assess the area remotely and prioritize, and the urgency flag separates a minor query from something needing immediate attention. Together they turn a worried message into something you can triage safely and act on fast.

Is this complication reporting template free?

Yes, completely free. Add or remove fields, adjust it to fit your clinic’s protocols, and restyle it to your brand, then embed it on your site or share a link — no coding needed. A free Fun Forms account lets you collect reports.