Client Consultation Card (Basic)

Compact A5 consultation card with medical history, allergies, patch test record and treatment log.

BeautyKiln Document Hub - Client Consultation Card - Free to use, no attribution required

Client Consultation Card

This is a compact, everyday consultation card designed to fit on a single A5 sheet (front and back). Use it for every new client and update it at each visit.

Client Details

Full name: ______________________________

Date of birth: //________

Address: ______________________________

Postcode: ________________

Phone: ______________________________

Email: ______________________________

Emergency contact name: ______________________________

Emergency contact phone: ______________________________

How did you hear about me? ______________________________

Medical History

Please tick any conditions that apply to you. If you are unsure, please ask.

• Epilepsy
• Diabetes
• Heart condition
• High or low blood pressure
• Skin conditions (eczema, psoriasis, dermatitis)
• Asthma
• Hay fever
• Pregnancy or breastfeeding
• Recent surgery (within the last 6 months)
• Metal pins, plates or implants
• Circulatory problems
• Nervous system disorders
• Cancer or history of cancer
• Autoimmune condition
• Keloid scarring
• Cold sores (herpes simplex)
• Eye conditions or recent eye surgery
• None of the above

Allergies

Do you have any known allergies? Yes / No

If yes, please list them:

Are you allergic to plasters, latex or adhesive tape? Yes / No

Medications

Are you currently taking any medication (including over-the-counter)? Yes / No

If yes, please list:

Are you using any topical products (retinol, prescription creams, acids)? Yes / No

If yes, please specify:

Patch Test

Treatment requiring patch test: ______________________________

Patch test date: //________

Patch test result: Negative (no reaction) / Positive (reaction noted) / Not required

If positive, describe the reaction: ______________________________

Treatment Requested

Treatment: ______________________________

Areas to be treated: ______________________________

Any specific concerns or requests: ______________________________

Consent

I confirm that the information I have provided is accurate and complete to the best of my knowledge. I understand that it is my responsibility to inform my practitioner of any changes to my medical history, medications or allergies.

I consent to the treatment described above and confirm that the treatment, aftercare and any risks have been explained to me.

Client signature: ______________________________

Date: //________

Practitioner signature: ______________________________

Date: //________

Treatment Log

Use this table to record each visit. Continue on a separate sheet if needed.

How to use this template

This is a basic, all-purpose consultation card. Use it for every new client before their first treatment.

Tips:

• Print it double-sided on A5 card stock. Client details and medical history on the front, treatment log on the back.
• Ask the client to fill in their details themselves. Go through the medical history section together so you can ask follow-up questions.
• Update the medical history at least every 12 months, or whenever a client tells you something has changed.
• Record every treatment in the log - even if it is the same treatment as last time. Include products used and any notes (e.g. skin reaction, colour formula, tension preference).
• Store completed cards securely. If you keep paper records, use a locked box or drawer. If you keep digital records, make sure they are password-protected and backed up.
• Keep client records for at least 7 years after the last appointment (longer for treatments on under-18s).
• This card includes a basic consent statement. For treatments with higher risk (e.g. semi-permanent makeup, chemical peels, lash lifts), use a separate, treatment-specific consent form as well.
• If a client discloses a medical condition you are unsure about, ask them to get a GP letter confirming they are safe to have the treatment before you proceed.