Facial and extractions consent form: setting limits before you touch a pore
A classic facial feels like the lowest-risk service on the menu, and clients treat it that way. Then they get home, see small red dots where pores were cleared, and a few days later notice whiteheads. Without a word in writing, both of those look like something went wrong.
This exact form is built into SlickChart: send it to your client's phone to sign before the visit.
The facial consent form is less about scary risks and more about expectations and limits: what you will and will not extract, what the skin will look like for a week, and how a client can tell normal from not normal.
Say what the facial includes
My form describes a custom facial as cleanse, exfoliate, optional steam, extraction of clogged pores, massage and a mask. Listing the steps matters because each one can be skipped for a reason, and the client should know that is possible before the day.
What they will feel: mostly relaxing, with extractions feeling like firm pressure that may sting, and they can ask you to ease up or stop at any time. What to expect: pinkness for a few hours and small marks for 1 to 2 days, and stubborn pores may take several visits. Other options include a facial without extractions or steam, homecare only, or a dermatologist referral.
That "stubborn pores may take several visits" line saves you from the client who expects every blackhead gone in one session.
Put your extraction limits in writing
This is the most useful line on the whole form:
Only clogged pores are extracted. Inflamed or deep blemishes are left alone or referred.
It does three jobs. It sets a boundary the client agrees to before they are on the table asking you to "just get that one". It records your standard of practice. And it keeps you inside your scope, with a referral as a perfectly good answer.
Risks, honestly sized
The risks are modest but real: redness, swelling or tenderness for a day or two; dark marks, more likely in deeper skin tones; an allergic or irritant reaction to a product; small scabs, bruising or broken capillaries; a few new breakouts over the next week; and infection or scarring, which is rare. Listing "a few new breakouts" up front is what makes the purging talk later believable.
Contraindications that change the plan
The framing on my checklist is gentle on purpose:
"A yes doesn't always mean no facial. I may skip steam or extractions, change products, or reschedule."
For a facial, that is usually the real outcome. The list asks about isotretinoin now or in the past 6 months, a prescription retinoid in the past 7 days, a peel, laser, Botox or filler in the past 2 weeks, facial waxing or depilatory in the past 3 days, blood thinners or bruising easily, rosacea, broken capillaries or heat sensitivity, asthma or trouble breathing in steam, a sunburn, rash, cold sore or open wound, pregnancy or nursing, and allergies to skincare, latex, nuts or fragrance.
The checklist helps you tailor the service; it is a screening tool, not a diagnosis.
The acknowledgements are brief: complete and honest health history with changes shared before each visit, results vary, they will follow aftercare and not pick, and they can stop any part of the treatment at any time. Add photo permission choices and a parent or guardian line for minors.
Aftercare that explains purging
The single most helpful thing in my facial aftercare is a side by side description of purging and a reaction:
- Purging usually looks like small whiteheads or blackheads in the places they normally break out, showing up within a few days and clearing within about a week.
- A reaction or breakout looks like red, itchy, burning or painful bumps, or spots in new areas, that keep coming or last longer than 2 weeks. That is a message to you.
Around it, the timeline is simple: makeup off for 12 to 24 hours, no touching, workouts, sauna or pools on day 0; no retinol, acids, scrubs or waxing for 48 hours; a clean pillowcase and phone screen; and no squeezing at home, because it can push debris deeper and leave dark marks or scars. The "call me" list includes swelling or pain that gets worse, oozing or a red streak, redness past 2 to 3 days, a rash after new products, or a painful deep bump where a pore was cleared. Trouble breathing or swelling of the face or throat means calling 911.
Questions to decide for your own practice
- Where is your line on extractions, and how will you explain a referral?
- Which contraindications mean skipping steam, and which mean skipping extractions?
- How soon will you rebook, and will the reminder go out automatically? (Solo esthetician rebooking covers this.)
- What does your state board say about extractions and consent? Requirements and scope of practice vary by state, so check with yours. This is not legal or medical advice.
Use this form with your clients
SlickChart has this exact facial and extractions consent and aftercare built in for esthetician subscribers. The client signs on their phone before the visit, or on your device in the room, and any contraindication they check is flagged for you. The aftercare goes to the client's own app, styled with your logo, and it works alongside the Square account you already have. If that would make your mornings easier, try SlickChart.
Prefer paper? The printable facial and extractions set, with the consent form, protocol and aftercare, is in my Etsy shop, ready to print or edit in free Canva.