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Esthetician Client Intake Form

Esthetician Client Intake Form Template for Indonesia

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Key Requirements PROMPT example:

Esthetician Client Intake Form

"I need an Esthetician Client Intake Form for my new medical spa opening in Jakarta in March 2025, focusing on advanced skin treatments and requiring detailed medical history collection, with extra emphasis on contraindications for chemical peels and laser treatments."

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Document background
The Esthetician Client Intake Form is a crucial document used in Indonesian beauty and wellness establishments to gather essential information before providing aesthetic treatments. This form serves multiple purposes: it collects client personal and medical information, documents informed consent, and ensures compliance with Indonesian healthcare and data protection regulations, including Law No. 36 of 2009 on Health and the PDP Law of 2023. The form is designed to protect both the service provider and client by thoroughly screening for contraindications, documenting treatment history, and establishing clear communication about expected outcomes. It should be completed before the first treatment and updated periodically to maintain accurate records.
Suggested Sections

1. Personal Information: Client's basic details including name, date of birth, contact information, and emergency contact details

2. Medical History: Comprehensive health history including current medications, allergies, and medical conditions that might affect treatments

3. Skin Assessment: Current skin conditions, concerns, and treatment objectives

4. Current Skincare Routine: Products and treatments currently used by the client

5. Treatment History: Previous aesthetic treatments, reactions, and outcomes

6. Lifestyle Factors: Information about sun exposure, diet, smoking, and other factors affecting skin health

7. Consent and Acknowledgment: Client's agreement to treatment terms and acknowledgment of risks

8. Photo Consent: Permission to take and use before/after photos for treatment tracking

9. Data Protection Notice: Information about how personal data will be collected, used, and protected as per Indonesian PDP Law

Optional Sections

1. Pregnancy Declaration: Additional section for female clients of childbearing age to declare pregnancy status

2. Special Treatment Consent: Specific consent forms for advanced treatments like chemical peels or microdermabrasion

3. Insurance Information: Section for clients using health insurance for medical-grade treatments

4. Cultural/Religious Considerations: Section for noting any cultural or religious preferences affecting treatment

5. Language Preference: For areas with diverse populations to note preferred language for communication

Suggested Schedules

1. Treatment Menu Price List: Current pricing for all available treatments

2. Treatment Contraindications List: Detailed list of conditions that may prevent certain treatments

3. Post-Treatment Care Instructions: General guidelines for after-treatment care

4. Cancellation Policy: Details of appointment cancellation and rescheduling policies

5. Product Ingredient List: Common ingredients used in treatments for allergen screening

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions






























Clauses




















Relevant Industries

Beauty and Wellness

Healthcare Services

Medical Aesthetics

Spa and Relaxation

Cosmetic Services

Personal Care Services

Professional Services

Health and Beauty Retail

Relevant Teams

Operations

Client Services

Compliance

Medical Records

Front Office

Treatment

Quality Assurance

Legal

Administration

Relevant Roles

Esthetician

Spa Manager

Beauty Therapist

Clinic Director

Skincare Specialist

Medical Esthetician

Beauty Salon Owner

Compliance Officer

Health and Safety Manager

Client Relations Manager

Treatment Coordinator

Front Desk Coordinator

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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