Templates / IPL Consultation & Medical History
IPL-01 · IPL
IPL Consultation & Medical History
Full intake form with Fitzpatrick skin type and medication review.
RM35Buy now
Details
- Printable A4 PDF · 3 pages
- Edit in free Canva: add your logo, change the wording
- 7 languages included: English, Bahasa Melayu, Bahasa Indonesia, 简体中文, Español, Français, العربية
- Instant download after payment
- For use in one business
What's inside
A detailed three-page IPL hair removal consultation form: treatment areas, hair colour and removal history, 13 medical screening questions, medication and skincare, Fitzpatrick skin type, therapist suitability decision and a signed client declaration.
- Client details
- Treatment area
- Hair and hair removal history
- Medical history
- Fitzpatrick skin type (therapist to assess with chart IPL-04)
- Therapist record
- Client declaration
The Indonesian, Chinese, Spanish, French and Arabic versions are new translations. Please read through them and adjust the wording for your region before use.
