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Patient Intake Form

A patient intake template for UK aesthetic clinics, written by a UK aesthetic physician, designed to stand up to scrutiny. Generic forms don’t.

£8 Single-clinic licence · Instant download
Launching this week

UK Consumer Contracts Regulations 2013 apply — digital downloads non-refundable once delivered.

Patient Intake Form — substrate cover page
£8 Patient Intake Form
Get early access

What's inside

The 4-file bundle.

01

Branded interactive PDF

For iPad and tablet workflows. Patient details, tick-boxes, initials boxes, and signature pads are all fillable on screen. Patients sign with a finger, Apple Pencil, or stylus.

02

Branded editable Word document

For clinics that prefer print, customise, and sign on paper. Find-and-replace targets are highlighted throughout — three minutes from download to deployable.

03

Plain clinical content (Word)

Clean clinical text, no branding or signature blocks. Drop directly into Pabau, Jotform, Faces, Aesthetic Nurse Software, or any digital consent platform.

04

Instructions PDF (2 pages)

Explains which file is for which workflow, the find-and-replace process, and how to deploy each variant.

What's covered

Clinical scope.

  • Demographics, GP details, medical history, medications, allergies, aesthetic history, lifestyle, clinical photography, GDPR.

Product brands

Universal — works for any UK aesthetic, dermatology, or cosmetic clinic.

The detail

Why this isn't a £5 Canva template.

GDPR-compliant from the ground up. Captures every disclosure that matters when something is later questioned.

Real headings, real medical history depth, not a generic web form.

Photography and marketing consent dovetails directly with the dedicated photography consent template.

Initialling and signature blocks aligned to UK clinical record-keeping standards.

Single-clinic licence.

FAQ

Common questions.

Can I edit it?
Yes. The branded Word doc is fully editable. All clinic-specific placeholders are highlighted as find-and-replace targets — three minutes from download to deployable.
Will it work with Pabau, Jotform, Faces or ANS?
Yes. The plain content Word doc is built specifically for paste-into-platform workflows. Real heading styles, no logo, no signature blocks — the platform handles those natively.
Do I have to credit Cleritas?
No. The footer credit line is licence-required, but you can present the form to patients as your clinic’s document. That’s the whole point.
What if I run multiple clinics?
Get in touch before purchase. Multi-site and group licences are available at standard tiers. Single-clinic licence covers one trading location only.
Is it MHRA / GMC / NMC certified?
No template can be, and any template claiming to be should be a red flag. This is a clinician-authored document aligned with UK consent standards. You remain professionally responsible for your consent process.

Ready to deploy?

This template launches this week. Get on the early-access list and you’ll be the first to know.