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Consent and Waiver Form

A consent and waiver template — capture informed consent with a digital signature, flagging pregnancy, recent treatments and relevant products.

Description

Any treatment that carries risk needs consent on record, and a flexible waiver covers the basics for a range of services. This consent and waiver form captures a client’s agreement and key screening answers, with a digital signature, before treatment.

It takes the client’s name, asks whether they’re pregnant or nursing, and whether they’ve had recent surgery, cosmetic treatments or skin issues, with space for details. It checks whether they’re using any listed products, and captures their consent and signature.

Use it as an adaptable consent and waiver for treatments that need one, tailoring the questions to the service. A signed record shows the client consented and was screened. Customize the fields, add your branding, and embed it on your site or share a link in minutes.

Form fields

Everything the Consent and Waiver Form above collects — 7 fields, so you can see exactly what it captures before you make it your own.

Treatment Consent & Waiver

  • Name

    Name Icon
    Name

  • Are you pregnant or nursing?

    Yes/No Icon
    Yes/No

  • Have you had any recent surgery, cosmetic treatments, or skin issues?

    Yes/No Icon
    Yes/No

  • Please provide details:

    Long Answer Icon
    Long Answer

  • Are you currently using any of the following?

    Multi-Select Icon
    Multi-Select

  • Consent

    Multi-Select Icon
    Multi-Select

  • Signature

    Short Answer Icon
    Short Answer
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Template FAQs

Common questions about the Consent and Waiver Form — what it captures, when to use it, and how to make it your own.

What is a consent and waiver form?

A consent and waiver form records that a client agreed to a treatment after basic screening, and captures their signature. It’s an adaptable consent document for treatments that need one, protecting both the client and the practitioner.

What should a consent and waiver form include?

This form captures the client’s name, whether they’re pregnant or nursing, whether they’ve had recent surgery, cosmetic treatments or skin issues with space for details, whether they’re using any listed products, and their consent and signature.

When should a client sign a consent and waiver?

Before the treatment begins, every time. Consent given and screening completed beforehand is what makes the waiver meaningful — it confirms the client understood and agreed, and that key contraindications were checked, before anything went ahead.

Who should complete a consent and waiver form?

Every client before a treatment that requires consent. The form captures their screening answers and signature, so the practitioner has a documented record that the client was informed, screened and agreed to proceed — a record that protects both sides if a question ever arises.

Can this waiver be adapted for different treatments?

Yes — it’s built to be flexible. Because you can change the screening questions and listed products to match the service, the same consent and waiver works across a range of treatments rather than being tied to one, saving you building a form for each.

Is this consent and waiver template free to use?

Yes, completely free. Adjust the screening questions and wording to fit each treatment, 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 signed consent.

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