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Skin Analysis Intake Form

A skin analysis intake template — capture a detailed skin-health picture before a treatment plan: concerns, lifestyle, products and medication.

Description

A treatment plan is only as good as the skin picture behind it. This skin analysis intake form captures a detailed skin-health history before you plan treatment, so your recommendations are grounded in the client’s real skin and lifestyle.

It asks the client to describe their skin and the concerns to address, and captures lifestyle factors and the products they currently use. It checks whether they’re on any skin medication such as Roaccutane, asks about listed conditions and allergies, and confirms accuracy.

Send it before a consultation or share a link ahead of a treatment plan. A full skin history means safer, more effective recommendations. Customize the fields, add your branding, and embed it on your site or share a link in minutes.

Form fields

Everything the Skin Analysis Intake Form above collects — 12 fields across 2 pages, so you can see exactly what it captures before you make it your own.

Your Skin Health Profile

  • How would you describe your skin?

    Dropdown Icon
    Dropdown

  • Concerns to address

    Multi-Select Icon
    Multi-Select

  • Lifestyle factors

    Multi-Select Icon
    Multi-Select

  • List the skincare products you currently use

    Long Answer Icon
    Long Answer

  • Are you on any skin medication (e.g. Roaccutane)?

    Yes/No Icon
    Yes/No

  • If yes, please give details

    Long Answer Icon
    Long Answer

Health & consent

  • Any of these?

    Multi-Select Icon
    Multi-Select

  • Allergy details

    Long Answer Icon
    Long Answer

  • Accuracy

    Consent Icon
    Consent

  • Full name

    Name Icon
    Name

  • Email address

    Email Icon
    Email

  • Contact number

    Telephone Icon
    Telephone
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Template FAQs

Common questions about the Skin Analysis Intake Form — what it captures, when to use it, and how to make it your own.

What is a skin analysis intake form?

A skin analysis intake form captures a detailed picture of a client’s skin health — their concerns, lifestyle, products and medication — before a treatment plan. It gives the therapist the information to recommend treatments grounded in the client’s real skin, safely.

What should a skin analysis intake include?

This form asks the client to describe their skin and the concerns to address, and captures lifestyle factors, the products they use, whether they’re on skin medication like Roaccutane, any listed conditions, allergy details, and a confirmation of accuracy.

When should a client complete a skin analysis intake?

Before a consultation or treatment plan, ideally ahead of the appointment. Capturing the full skin history beforehand gives the therapist time to review it and build a considered plan, rather than assessing everything from scratch in the room.

Who fills out a skin analysis intake form?

Clients before a skin consultation or treatment plan. The form captures their skin history, products and medication, so the therapist can assess the skin properly and recommend a safe, effective course tailored to the client.

Why ask about medication like Roaccutane on a skin intake?

Because certain skin medications, particularly isotretinoin (Roaccutane), make the skin far more sensitive and rule out many treatments for months. Knowing about them is essential to treating safely — some treatments must wait until well after the medication ends.

Is this skin analysis intake template free?

Yes, completely free. Add or remove fields, adjust it to fit your treatments and standards, 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 responses.

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