Microdermabrasion Consent Form
A microdermabrasion consent form screens for active skin conditions and medications that thin the skin, records skin type, and documents the client's agreement before mechanical exfoliation.
No credit card required.
Mechanical exfoliation needs its own screening
Microdermabrasion physically removes the outer layer of skin. On skin thinned by retinoids or isotretinoin, or over active acne, it can cause abrasions, irritation or pigment changes.
GlowForms has versions of this template with a built-in Fitzpatrick skin-type assessment, so the skin type is recorded with the consent.
What to screen before microdermabrasion
- Isotretinoin in the past 6 months and topical retinoids in the past week
- Active acne, rosacea flare, eczema or open lesions in the area
- Active cold sores
- Sunburn or recent tanning
- Blood thinners or easy bruising
- Recent waxing, peels or laser in the area
- Skin type — the Fitzpatrick versions add a structured assessment
Reactions to explain before treatment
- Redness and a mild warm feeling for a few hours
- Light dryness or flaking
- Less common: abrasion, temporary pigment changes
Aftercare the client acknowledges
- SPF daily and limited sun exposure
- No exfoliants or retinoids for several days
- Gentle cleanser and moisturizer only
Microdermabrasion templates in GlowForms
Pick the version that matches how you work, then add your logo and your own questions.
- • Microdermabrasion - Intake & Consent
- • Microdermabrasion - With Fitzpatrick Assessment
- • Microdermabrasion - With Fitzpatrick & Cancellation Policy
- • Microdermabrasion - With Fitzpatrick + Photo & Video Release
- • Microdermabrasion - With Fitzpatrick, Cancellation + Photo & Video Release
- • Microdermabrasion - With Cancellation Policy
- • Microdermabrasion - With Photo & Video Release
- • Microdermabrasion - With Cancellation + Photo & Video Release
- • Microdermabrasion - Care Advice (aftercare sheet you send after the visit)
How it works
- Attach the form to your microdermabrasion service.
- When a client books, they get the form by email and complete it on their phone.
- You see their answers and signature before the appointment, and they stay in the client record.
FAQ
Why record Fitzpatrick skin type on a microdermabrasion form?
Deeper skin tones are more prone to pigment changes after exfoliating treatments. Recording skin type helps you choose settings and shows you assessed it.
How often should clients re-sign?
When their medications, skin condition or your treatment protocol changes, and at least once a year.
General information, not legal or medical advice. Adapt every form to your state's rules, your insurer's requirements and the product manufacturer's protocol.