Med spa intake form checklist, and what to keep separate

A filler appointment that stops because the client mentions a bleeding disorder at the chair costs the slot, the product prep and the client's trust. The FDA's own page on dermal fillers lists a bleeding disorder as something to tell the provider before the procedure. The intake form is where that should have come up, days earlier.

The short answer. A med spa needs three things, not one form. An intake form collects who the client is and their health history, once, and is updated at each visit. A screening checklist per treatment asks the questions that rule that treatment in or out. A signed consent per procedure records that the client understood the risks. Most templates online blur the three together. Keep them apart and each one gets shorter.

The intake form checklist

Collect this before the first visit, and ask the client to confirm or update it at every visit after.

Who the client is

• Full legal name, date of birth and preferred name
• Phone, email and mailing address
• Emergency contact and their relationship
• How they heard about you

Health history

• Current medications, including blood thinners, and supplements
• Allergies, including local anesthetics such as lidocaine, latex and any product ingredient
• History of severe allergic reactions or anaphylaxis
• Bleeding or clotting disorders
• Autoimmune conditions and conditions that affect healing
• History of keloids or raised scars
• History of cold sores
• Pregnant, trying to become pregnant or breastfeeding
• Isotretinoin (Accutane and its generics) now or in the past year
• Prescription retinoids on the skin

Skin and treatment history

• Skin concerns and goals, in the client's own words
• Past injectables, fillers, lasers and peels, with dates and where
• Any reaction to a past treatment
• Recent sun exposure, tanning or self-tanner

Acknowledgments

• The information is complete and accurate, and the client will tell you of changes
• Cancellation and no-show policy
• Photo consent, with a separate yes or no for marketing use
• Notice of privacy practices, if you are a HIPAA covered entity (see below)

Screening questions by treatment

These sit on top of intake. Your medical director sets the final list, because the right questions depend on the product and the device.

Dermal fillers. FDA tells patients to alert their provider before the procedure if their skin is inflamed or infected, they have a bleeding disorder, they have severe allergies or a history of anaphylaxis, or they are allergic to local anesthetics such as lidocaine, to collagen or eggs, to animal products or to bacteria. For filler in the hands, FDA adds joint, tendon or blood vessel disease in the hand. FDA also says filler safety "is unknown when used during pregnancy, while breast feeding, and in patients under 22 years of age", and in people prone to keloids or raised scars. Each of those is a screening question.

Lasers, peels, dermabrasion and microneedling. Ask about isotretinoin and when it was stopped. The guidance here is less settled than most forms suggest. The current isotretinoin label tells patients to avoid "wax epilation and skin resurfacing procedures (such as dermabrasion, laser)" during treatment and for at least 6 months after. A 2017 guideline in the Journal of Cutaneous and Aesthetic Surgery found "insufficient evidence" to support delaying most procedures, including laser hair removal, fractional lasers and microneedling. It kept a 6-month window for aggressive ones such as dermabrasion, full-face ablative laser resurfacing and deep peels. Ask the question on the form, and let the clinician decide.

Neurotoxins. Ask about neuromuscular conditions, pregnancy and breastfeeding, and the last treatment date. Check the screening questions against the product's label, which your medical director has.

What goes on the consent instead

A consent is signed per procedure, after the consultation. It names the treatment, the product, the risks and alternatives, and what aftercare looks like. It is not a box on the intake form. A client can complete intake at home on Monday and sign the filler consent in the room on Friday, once the clinician has explained it.

When HIPAA applies

CMS's guide "Are You a Covered Entity?" says "Providers who submit HIPAA transactions, like claims, electronically are covered." A med spa that bills insurance electronically, even for some services, is almost certainly a covered entity. A cash-only med spa may not be. Ask counsel, because state privacy laws can apply either way.

If you are covered, any vendor that stores your intake forms is a business associate. CMS's guide says the covered entity "must have a written business associate contract or other arrangement" with it. In practice that is a business associate agreement, or BAA. Get it signed before the first client fills in a form online.

A worked example

Take a med spa that sees 40 new clients a month and fills in intake on a clipboard in the lobby. Assume each form takes 12 minutes to fill in and enter, and that this is your own estimate, not a measured number.

That is 40 times 12, which is 480 minutes, or 8 hours a month of front desk and client time. Over a year it is 96 hours.

Sending the form when the booking is made moves that time out of the lobby. The client answers at home, the clinician reviews it the day before, and a red flag such as a bleeding disorder comes up before the slot is lost.

When a check fails

• A screening answer rules the treatment out. Call the client before the visit, explain why, and offer an alternative or a consultation instead.
• The form is incomplete. Don't start the treatment. Finish the form in the room with the clinician.
• The answer changed since last time. Treat it as new. A new medication or a pregnancy changes the screening.
• The consent isn't signed. No treatment until it is.

Where software fits

Software for a med spa should send intake when the booking is made, store it with the client record, keep consents with an audit trail, and sign a BAA if you are a covered entity.

dailybuilt lets each service ask its own intake questions at booking on every plan, with 13 question types including yes or no, dates and file upload. Foundation, at $99 a month, adds documents and e-signature, with built-in informed consent, privacy practices acknowledgment and telehealth consent templates for healthcare workspaces. Healthcare Edition comes with a BAA on any plan; ask dailybuilt to switch it on. Every change to a client's record is logged. dailybuilt is not an EHR and keeps no treatment notes, so a practice that needs charting should keep its EHR. If you bill insurance after a visit, how to make a superbill for therapy covers the receipt side. Plans are on the pricing page.

Questions people ask

Is a spa intake form the same as a consent form?No. Intake collects who the client is and their health history. A consent is signed for each procedure, after the clinician explains the risks. Keep them separate so each stays short and the consent matches the treatment.

How often should I update my spa intake form?Ask the client to confirm or update their history at every visit, and collect a full new form at least once a year. A new medication or a pregnancy can change what is safe.

Can clients fill out the spa intake form before their appointment?Yes, and it's better that they do. It gives the clinician time to review answers and call about a red flag before the slot is lost. If you are a HIPAA covered entity, make sure the online form's vendor has signed a BAA.

Do I need a separate intake form for each spa service?No. Use one intake form, then add screening questions for each treatment on top. The treatment-specific part is what changes between a filler, a laser and a peel.