The ultimate aesthetic interest questionnaire template for your practice

An aesthetic interest questionnaire template is a pre-consultation form that captures a new patient’s goals, concern areas, and medical history before their first visit.

The complete template sits further down this page, organized into six sections and free to copy. No signup, no purchase, no waiting on a file. Skip straight to the template if that is all you came for.

In practices we onboard, this is the first form a new patient ever completes. The answers decide how much of the consultation goes on history-taking rather than treatment planning.

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Key takeaways

An aesthetic interest questionnaire collects a prospective patient’s goals, concern areas, and medical history before the first consultation.

The full template is published on this page as the 6-part aesthetic intake framework, free to copy with no signup.

The six sections are personal information, areas of concern, desired outcomes, previous treatments, lifestyle and health, and treatment preferences.

A concern-to-next-step table maps each commonly ticked concern to the treatment category it usually opens at consultation.

Sent digitally through practice management software like Pabau, the answers land in the patient’s record before the patient arrives.

Why an aesthetic interest questionnaire is worth sending

An aesthetic interest questionnaire matters because it moves history-taking, goal-setting, and suitability screening out of the consultation room and into the week before it.

Collecting that detail up front gives you a treatment plan to discuss rather than a blank page. You already know the patient’s goals, their expectations, and the medical history that might rule an option out.

Personalizing treatment plans

A completed questionnaire lets you walk into the consultation with two or three options already matched to what the patient said they wanted.

Two patients asking for a fresher face rarely want the same treatment. One means the hollowing under the eyes. The other means a jawline that has softened. The form tells you which, days before either of them sits down.

Improving communication

Written answers give the patient and the practitioner the same starting point, which is where most expectation mismatches get caught early.

Patients arrive with a picture in their head shaped by filtered images. Asking them to describe the result in their own words, in writing, brings that picture into the open. You can then correct it gently, with time to prepare, instead of improvising mid-consultation.

Streamlining consultations

Sending the questionnaire out with the booking confirmation saves the first ten minutes of every consultation, because nobody is filling in a clipboard in reception.

Pairing the form with your medical spa scheduling software means the send happens automatically at booking. Good medical spa software then carries those answers into every future visit, not just the first consultation.

Practice management software like Pabau stores the completed form against the patient’s record. Your team can open one screen and see goals, concerns, and medical history together. The same applies in skin clinics running dermatology practice management software.

The 6-part aesthetic intake framework and the questions in each section

The framework has six sections: personal information, areas of concern, desired outcomes, previous treatments, lifestyle and health, and treatment preferences.

Each section answers a question you would otherwise ask in the room. The examples below show what each one is for. The complete, copy-ready question set comes later, in the template itself.

1. Personal information

Personal information covers the patient’s name, date of birth, contact details, and how they found your practice.

The last field earns its place twice over. A referral source tells your marketing which channel is paying for itself. The same answer tells the practitioner whether this patient came on a friend’s recommendation or an advert.

2. Areas of concern

Areas of concern works best as a tick-box checklist split into face and body, so patients mark what bothers them instead of writing an essay.

On the face, the items patients tick most often are:

• Fine lines and wrinkles
• Facial volume loss, meaning flattened cheeks and hollowing under the eyes
• Submental fullness, which most patients call a double chin
• Sagging skin along the jaw and neck
• Pigmentation, brown spots, and sun damage
• Spider veins and broken capillaries around the nose and cheeks
• Lip shape and volume
• Acne and acne scarring

On the body, the common ones are:

• Stubborn fat that does not shift with diet or exercise
• Loose skin after weight loss or pregnancy
• Skin texture and cellulite on the thighs
• Spider veins on the legs
• Stretch marks and scars
• Unwanted hair
• Excessive underarm sweating

Leave one open field underneath. Patients describe concerns a checklist never anticipates, and that sentence is often the one you lead the consultation with.

3. Desired outcomes

Desired outcomes tells you whether the patient wants a subtle refresh or a visible change, and how quickly they expect to see it.

Ask for the motivation as well as the result. A patient booking before a wedding has a deadline you need to plan backwards from. A patient who simply feels tired-looking has no deadline at all, and a very different tolerance for downtime.

4. Previous treatments

Previous treatments tells you what has already been done, when, by whom, and whether anything went wrong afterwards.

Dates matter more than most forms allow room for. Knowing a patient had filler four months ago rather than four years ago changes what you can safely plan at the first appointment.

5. Lifestyle and health considerations

Lifestyle and health considerations flags the conditions, medications, allergies, and habits that change recovery time or rule a treatment out entirely.

How many questions you need here depends on your menu. A solo injector can keep this section short. A multi-location medspa offering laser, body contouring, and injectables needs an extra block of questions for each modality it runs.

6. Treatment preferences

Treatment preferences asks how far the patient is willing to go, from topical treatments through to injectables and surgery.

Some patients arrive open to surgery and will sign a cosmetic surgery consent form at the first visit. Others want lasers and topical creams only. Minimally invasive treatments such as botulinum toxin and fillers rose by over 70% in 2022 compared with 2019. That figure comes from Fox 13’s investigation into the plastic surgery boom.

Knowing where a patient sits on that scale before the consultation stops you pitching something they were never going to accept.

Which concern points to which next step

The table below maps each commonly ticked concern to the treatment category it usually opens and what the patient should have ready.

Nothing in that table is a recommendation. Suitability is decided in the consultation, by the practitioner, against the patient’s full history. The table exists so your front desk knows what to ask for in advance, and so the practitioner is not starting cold.

Customizable aesthetic interest questionnaire template for your practice

Here is the full aesthetic interest questionnaire template, free to copy, organized into the six sections of the framework above.

Paste it into your form builder, your EMR, or a printed handout, then cut the questions that do not apply to your treatment menu. The structure below is the map.

Section 1: Personal information

• Full name
• Date of birth
• Email address and mobile number
• Preferred contact method
• How did you hear about us?
• Is this your first aesthetic appointment anywhere?
• Emergency contact name and number

Section 2: Areas of concern

Which areas of your face concern you? Tick all that apply.

• Fine lines and wrinkles
• Facial volume loss in the cheeks or under the eyes
• Submental fullness (a double chin)
• Sagging jaw or neck skin
• Pigmentation, brown spots, or sun damage
• Spider veins and broken capillaries
• Lip shape or volume
• Acne or acne scarring

Which areas of your body concern you? Tick all that apply.

• Stubborn fat
• Loose or sagging skin
• Cellulite or skin texture
• Spider veins on the legs
• Stretch marks or scars
• Unwanted hair
• Excessive sweating

Then ask the four follow-up questions.

• Which single concern bothers you most?
• How long has that concern bothered you?
• How would you rate the overall condition of your skin?
• Is there anything else you would like us to look at?

Section 3: Desired outcomes

• How do you picture your appearance after treatment?
• Are you looking for a subtle enhancement or a more noticeable change?
• What is your main motivation: confidence, comfort, an upcoming event, or something else?
• Is there a date you would like to look your best by?
• How much downtime can you take after a treatment?
• Do you have any concerns or reservations about the treatment process?

Section 4: Previous treatments

• Have you had any aesthetic treatments before?
• Which treatments, and roughly when?
• Where were they carried out, including any treatment abroad?
• Were you happy with the results?
• Did you have any side effects or complications?
• Do you have any permanent or semi-permanent filler in place?
• Can you share any before-and-after photos?

Section 5: Lifestyle and health considerations

• How would you describe your general health?
• Do you have any chronic conditions we should know about?
• Are you taking any medications or supplements?
• Do you have any allergies or known sensitivities?
• Are you pregnant, breastfeeding, or planning a pregnancy?
• Do you smoke, and how often do you drink alcohol?
• How often are you in the sun, and do you use sunscreen daily?
• How would you describe your activity levels?

Section 6: Treatment preferences

• Are you open to injectable treatments?
• Would you consider a surgical option, or would you rather not?
• Do you prefer non-invasive treatments such as lasers or topical creams?
• Are there specific treatments you have read about and want to discuss?
• Are there any treatments you would like to rule out?
• Do you have a budget range in mind for this course of treatment?
• Would you like to be contacted about follow-up appointments?

Download the template

How Pabau sends and files your patient questionnaires

Pabau sends the questionnaire with the booking confirmation, collects it on the patient’s phone, and writes the answers straight into their record.

Without a digital form, the send-out stays manual. Someone emails a PDF, the patient prints it or forgets, and reception ends up handing over a clipboard on arrival. The answers then get retyped into the system, or left in a paper file nobody opens again.

What happens after the patient hits submit is the part that changes the workday. The answers attach to that patient’s record automatically, so there is no retyping and no second version of the truth. Pabau GO, our iOS app for practitioners, shows the same answers as a pre-appointment checklist.

Your practitioner opens the record before the patient walks in and already knows the concern areas, the previous treatments, and the medical history. The consultation starts at the treatment plan instead of at the paperwork. Practices also use this moment to prepare for the consultation properly.

• Swap the paper questionnaire for a fully digital, paperless process
• Use our form templates, customize them, or build your own from scratch
• Walk into consultations already knowing what the patient wants
• Keep every answer in the patient’s record, updated automatically

Collect intake answers before the patient arrives

Pabau sends your aesthetic interest questionnaire with the booking confirmation and files every answer against the patient’s record. Your practitioners open one screen and start the consultation already briefed.

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Conclusion

A questionnaire only earns its keep if it reaches the patient early and reaches the practitioner unaltered. A paper form handed over in reception fails on both counts.

So take the six sections above, cut what does not fit your treatment menu, and put the result somewhere it sends itself. The questions are the easy part. The send-out and the filing are what decide whether anyone reads the answers.

Book a demo to see how Pabau sends your intake forms at booking and files the answers against each patient’s record.

Continue your research

Running botulinum toxin treatments? Botox treatment note template sets out the fields a treatment record needs alongside your intake questionnaire.

Taking before-and-after photos? Before and after photo consent form requirements explains what your consent wording has to cover.

Running facial consultations too? Facial intake form covers the skin history and questions that belong on a facial consultation form.

Offering surgical procedures? Cosmetic surgery consent form gives you the consent document that follows this questionnaire.

Preparing for the appointment itself? How to prepare for a cosmetic consultation covers what to do with the answers once you have them.

Frequently asked questions