Trichology Intake Form

Take the guesswork out of client consultations with this comprehensive Trichology Client Intake Form. Designed for trichologists, hairstylists, scalp specialists, and beauty professionals, this professionally structured form helps you gather the essential information needed to assess hair loss, scalp concerns, lifestyle factors, medical history, and hair care habits.

Whether you're conducting in-person or virtual consultations, this intake form streamlines your process, improves client communication, and allows you to provide more personalized recommendations and treatment plans.

Perfect for:

• Trichologists
• Hairstylists
• Scalp Care Specialists
• Hair Loss Practitioners
• Beauty Professionals

What's Included:
✔ Comprehensive client information section
✔ Hair loss and scalp concern assessment
✔ Health and medical history questionnaire
✔ Lifestyle and nutrition review
✔ Current hair care practices evaluation
✔ Consultation-ready professional format
✔ Instant digital download

Save time, stay organized, and elevate your client experience with a professional intake form designed to support thorough hair and scalp assessments.

Format: Digital Download (Printable PDF)

Frequently Asked Questions

What fields does the intake form cover?

The form is organized into six core sections: personal & contact information (name, date of birth, contact details), chief concern (what brings the client in today), hair & scalp history (onset, duration, and progression of any changes), health & medical background (general wellness factors that can influence hair and scalp health), lifestyle & nutrition (diet, stress levels, sleep, and activity habits), and current hair care practices (products, tools, chemical services, and styling routines). Together these sections give the professional a well-rounded picture before the hands-on assessment begins.

What kind of scalp and hair-change history does the form ask about?

Clients are prompted to describe when they first noticed a change, whether the change has been gradual or sudden, the pattern of any shedding or thinning, and whether similar concerns have appeared in close family members. They are also asked about scalp sensations — such as itching, flaking, tenderness, or oiliness — and any previous professional assessments they may have had. This history helps the stylist identify patterns and tailor the consultation conversation accordingly.

Does the form ask about recent treatments or chemical services?

Yes. Clients are asked to list any chemical services received in the past 12 months (colour, bleach, relaxer, keratin treatments, perms), as well as any over-the-counter or prescribed topical products currently used on the scalp or hair. This information helps the professional understand potential contributing factors to the client's current hair and scalp condition before making any product or care recommendations.

How is client information kept private?

This is a downloadable template — your practice's own privacy and data-handling policies govern how completed forms are stored and protected. We recommend informing clients in writing how their information will be used, storing completed forms securely (password-protected digital files or locked physical storage), and retaining records only as long as needed in line with applicable local regulations. The form itself does not transmit or store any data; it is filled out and managed entirely within your workflow.

When should a stylist refer a client to a qualified clinician?

This intake form is an educational and organisational tool for hair and scalp professionals — it is not a diagnostic instrument. A stylist or scalp specialist should consider directing a client to a qualified medical professional (such as a dermatologist or GP) when a client reports: sudden or patchy hair loss that has developed rapidly; scalp symptoms including open sores, persistent pain, significant inflammation, or bleeding; hair loss accompanied by other systemic changes such as unexplained weight changes, fatigue, or hormonal shifts; or any situation where the professional is uncertain whether a condition falls within their scope of practice. When in doubt, referring out is always the right call — it protects both the client and the professional.

Is this form suitable for virtual consultations?

Absolutely. The form can be sent to clients digitally before an online session so they complete it in advance, giving the stylist or trichologist time to review the responses and prepare targeted questions. It works equally well for in-person appointments as a paper handout or a fillable PDF on a tablet.

Can I customise the form for my practice?

Yes — the printable PDF format is designed to be adapted. You can add your logo, practice name, and any service-specific questions that reflect your consultation process. We recommend keeping any additions within your professional scope and updating your privacy notice if you collect additional personal data.