Free form template
Dermal filler consent form
This dermal filler consent form template gathers the client's medical history, allergies, previous fillers, treatment areas and signed consent before the appointment. Use it free in the Managed Forms app, adapt the wording with your practitioner, and keep answers, photos and treatment notes together on one client record.
Free to use; paid Managed plans are optional. Email and SMS delivery uses message credits.
Consultation form
Example · Included on FreeSalon consultation
Questions, consent wording and signatures in one form.
Section · Your visit
What would you like us to know before your visit?
Long answer
Consent statement & signature
Add the wording your business has approved and a signature field.
Fictional client details. Explore the example; nothing is sent or saved.
Form preview
Dermal filler consent form preview
Structural outline for clinical review. Field labels show the expected answer type. This wording is draft until a nominated clinical reviewer approves it.
Pending clinical review before publish
Full name*
TextDate of birth*
DateContact email or phone*
Text
Do you have any current medical conditions?*
Yes / NoPlease list any relevant medical history
Text
Do you have any allergies or previous reactions to fillers?*
Yes / NoPlease list allergies or reactions
Text
Have you had dermal filler or related treatments before?*
Yes / NoPlease describe previous treatments
Text
Which treatment areas have been discussed?*
Text
I have discussed expected outcomes and limitations*
Checkbox
I have discussed the risks and aftercare for this treatment*
Checkbox
I consent to clinical photos being taken and stored on my record*
Yes / No
Client signature*
SignatureDate*
Date
Practitioner notes
TextPractitioner signature*
Signature
Clinical wording in this preview is draft and must be approved by a nominated clinical reviewer before publishing.
How it works
Choose a template, approve the wording with your practitioner, then share it before the appointment.
Example day
Choose
Choose the template
Open the form in the free Managed Forms app and adapt the sections for your service.
View step details
Who: You
You start from a treatment-specific outline instead of a blank page.
Edit
Edit and approve
Edit the questions and consent wording, then approve the version your clinic will send.
View step details
Who: You and your practitioner
Clients see the form your business has approved.
Share
Share and review
Share by link or QR code, or complete the form in person. Review answers with the client record before treatment.
View step details
Who: Client and practitioner
Answers stay on the client record for the next visit.
Available plans: Forms and client records are included with Free. Email and SMS delivery uses message credits.
What this form helps you record
Use the preview as a starting point. Your practitioner still reviews every response and decides whether to proceed. Clinical wording remains pending review.
Before the appointment
Collect history, acknowledgements and signed consent so answers are ready for discussion.
With the client record
Keep answers, photos and treatment notes together for the next visit or touch-up.
Take deposits when clients book
Protect high-value appointments with per-service deposits and cancellation cutoffs. Payments are powered by Stripe. When a deposit is refunded, the Managed fee on it is refunded too.
Per-service deposits
Set a different deposit and cancellation cutoff for each treatment.
No-show protection
Use saved-card booking and your own cancellation rules.
Stripe-powered payments
Take payment with the appointment. The Managed fee is refunded with any refunded deposit.
Already use another system? Migration is free from any provider. We'll handle the import for you, including photos and attachments, and setup help is next-day.
Free mobile app
Use this form free in Managed Forms
Open the free Managed Forms app on iPhone or Android, edit the wording with your practitioner and share by link or QR code. Free to use; paid Managed plans are optional.
Forms tools are free. Email and SMS delivery uses message credits. Other business tools depend on your plan.
Use this form free in Managed Forms
On your phone
Open the free Managed Forms app on your phone to use this template. Prefer a computer? Start free with Managed.
Questions about this form
Use this form for your next client
Open it in the free Managed Forms app, or start free with Managed to keep forms and bookings together.