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General Skincare Treatment Client Information & Consent Form Mobile App

The General Skincare Treatment Client Information and Consent Form mobile app is used to provide information on skincare treatments and to capture informed consent for treatment. Easily accessible from any smartphone or tablet, the app tracks details about the patient's health care history, skin care routine, current patient conditions, concerns about skin diseases and more.

The skin care app can also be customized to include your terms and conditions for payment and your own clinic's patient consent to treatment form. Once completed, the results are saved electronically for your records.

If you like this app, we would recommend checking out the client information app as well!

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the General Skincare Treatment Client Information & Consent Form Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Name

  • Ico textbox

    Address

  • Ico textbox

    City

  • Ico dropdown

    State

  • Ico textbox

    Zip

  • Ico textbox

    Phone

  • Ico textbox

    E-Mail

  • Ico textbox

    How did you hear about us?

  • Ico textbox

    Employer

  • Ico textbox

    Occupation

  • Ico textbox

    What would you like to achieve from your skin treatment today?

  • Ico dropdown

    Have you ever had a facial treatment or chemical peel before?

  • Ico dropdown

    Which of the following most closely describes your skin type?

  • Ico textbox

    Do you have any special skin problems or concerns?

  • Ico dropdown

    Do you use Retin-A, Renova, or Retinol/vitamin A derivative products?

  • Ico dropdown

    Have you used any alpha-hydroxy acid or glycolic acid products in the last 48 hours?

  • Ico dropdown

    Are you currently taking Accutane or have you taken it in the past?

  • Ico textbox

    How long ago?

  • Ico dropdown

    Have you used other acne medication?

  • Ico textbox

    If yes, which one?

  • Ico dropdown

    Are you exposed to the sun on a daily basis or do you use a tanning bed?

  • Ico statictext

    What skin care products are you currently using?

  • Ico textbox

    Cleanser

  • Ico textbox

    Mask

  • Ico textbox

    Eye Product

  • Ico textbox

    Exfoliation / Scrubs

  • Ico textbox

    Treatment / Acne product

  • Ico textbox

    Toner

  • ...and More!

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