Microneedling Consultation Form Template
Microneedling delivers real results, but only when it's right for the client in front of you. A thorough consultation form protects both of you.
Microneedling contraindications are serious. Active acne, blood thinners, recent retinol use, skin conditions like eczema or rosacea — any of these can turn a routine treatment into a problem if they aren't identified before you start. A verbal consultation during the appointment is better than nothing, but it's not the same as a structured intake that the client completes with time to think.
Typeform's microneedling consultation form walks clients through a comprehensive health and skin history before they arrive. Conditional logic builds a targeted picture: if they indicate current medication use, the form asks for specifics; if they've had recent skin treatments, it asks about the type and timing. Potential contraindications are surfaced before the appointment, giving you the chance to reschedule, adjust the treatment plan, or seek medical clearance.
Customize the form for your practice's protocols, send it with the booking confirmation, and walk into every treatment prepared.
A microneedling consultation form collects skin history, health information, and contraindication screening data from a client before a microneedling procedure. It helps practitioners assess suitability, identify risk factors, and confirm informed consent before treatment begins.
Microneedling is a medical-grade treatment with specific contraindications. A structured intake form ensures no critical health factors are missed, creates a documented record of client disclosure, and gives the practitioner a basis for adapting or declining the treatment when necessary.
Prioritize safety screening alongside skin goals. Key questions include:
- Active skin conditions (acne, rosacea, eczema, psoriasis)
- Current medications, especially blood thinners, retinoids, or antibiotics
- Recent cosmetic treatments (Botox, fillers, chemical peels, and timing)
- History of keloid scarring or poor wound healing
- Autoimmune conditions or immunosuppression
- Pregnancy or nursing status
- Skin concerns and treatment goals
- Previous microneedling or skin-needling experience
Use conditional logic to route high-risk responses to a specific message directing the client to seek physician clearance before the appointment. Configure a notification so you're alerted immediately and can follow up before the appointment date.
A new form should be completed before each treatment course, not just the first. Medications, skin conditions, and health status change. A brief update form before each session — rather than a full intake every time — captures material changes while respecting the client's time.
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