Most skin consultations are ten minutes of conversation that decide everything: whether the treatment is safe, whether the client comes back, and whether you find out about the Accutane course before or after the peel.
And most of them are run from memory. You ask what you remember to ask, in whatever order the conversation wanders, and the answers live in your head until you write the chart note that evening, by which point three clients have blurred together. That works right up until it doesn’t.
This is a list of the ten questions worth asking every time, in an order that builds on itself. Some of them are safety questions and some are business questions, and the honest thing to say up front is that the safety ones aren’t optional and the business ones are where your income actually comes from. It pairs with our esthetician client intake form guide, which covers the document while this one covers the conversation. If you run consultations outside skin work as well, the cross-discipline version is our top ten things to ask during a consultation.
1. “What made you book this appointment, specifically?”
Start open, then stay quiet, which is the hard half. There’s a well-known piece of research on this out of Mayo Clinic, published in the Journal of General Internal Medicine, where investigators recorded 112 clinical encounters and timed how long patients got to speak. Clinicians asked what the patient wanted to discuss in only 36% of visits, and interrupted seven times out of ten, at a median of 11 seconds. The part worth noticing is the other number: patients who weren’t interrupted finished stating their concern in a median of six seconds.
Six seconds. That’s the entire cost of shutting up.
The reason this matters more in esthetics than people assume is that the booked service and the actual concern are frequently different things. Someone books a hydrafacial because it was the treatment she’d heard of, and what she wants is for the texture on her jawline to stop. If you go straight to the treatment she booked, you deliver a service. If you ask first, you get a treatment plan.
Ask it as an open question, let the silence sit, and only then start narrowing.
2. “What are you using on your skin right now, and how often?”
Not “do you have a routine.” Ask for the actual products, in order, morning and night, including the ones she uses sometimes.
It’s the highest-yield question in a skin consultation, because home care is where most treatment complications are born. A client who’s on a prescription retinoid four nights a week is a different candidate for a peel than one who isn’t, and she may not think of it as skincare at all. It came from a doctor, so it goes in the medication bucket, and you asked about skincare.
The specific things you’re listening for: retinoids and retinol, and how recently they were used; acids, particularly if she’s layering two or three; benzoyl peroxide; anything from a dermatologist; and whether she’s started something new in the past fortnight. Our retinol calculator is a useful reference for what a reasonable strength and frequency looks like, and for spotting when a client has quietly worked her way up to a routine no one would prescribe.
Two follow-ups are worth the extra thirty seconds. “Show me on your phone” works better than a recall test, since most people have the products photographed or in an order history. And “what have you stopped using, and why?” is where you find the reactions she wouldn’t otherwise mention.
3. “What treatments have you had before, and how did your skin respond?”
Treatment history splits into three answers, and you want all three: what she’s had, when, and what happened afterwards.
The timing question is doing real work. Recent microneedling, a peel, laser, waxing, or injectables all change what’s appropriate today, and the intervals aren’t intuitive to clients. Someone who had filler placed nine days ago genuinely may not connect that to whether she should have a treatment involving heat or pressure over the same area.
“How did your skin respond” is the half that gets skipped, and it predicts today better than anything else she’ll tell you. A client who tells you she was red for four days after a superficial peel is telling you something useful about her barrier and her expectations, both. So is the one who says nothing happened at all, because that’s either a very conservative previous provider or a client whose definition of a result is going to be a problem in question seven.
If she’s had laser or peels elsewhere, ask what device or what solution, and don’t be embarrassed to write down a brand name you’ll look up later. “Some kind of laser” is not a history.
4. “Are you pregnant or breastfeeding?”
Ask it directly, ask it every time, and ask it in a way that doesn’t require an announcement. “Any chance you’re pregnant or breastfeeding right now?” gives someone at six weeks a way to say yes without starting a conversation about it.
It changes the menu. Several actives and most aggressive modalities come off the table, and the answer expires: a client you consulted with in March is not necessarily the same case in September. This is the clearest argument for running the medical questions at every visit rather than at intake once, which is why question nine exists.
5. “Have you ever taken isotretinoin? When did you finish?”
Accutane deserves its own question rather than a line in a medication list, because clients don’t reliably think of a course they finished two years ago as a current medical fact.
The guidance here changed, and a lot of training material hasn’t caught up. For about two decades the standing rule was a flat six-month wait after isotretinoin before any resurfacing procedure, based on a small number of case reports from the 1980s. In 2017 the American Society for Dermatologic Surgery convened a guidelines task force that reviewed 32 studies covering 1,485 procedures and found insufficient evidence to support delaying superficial chemical peels, laser hair removal, or fractional ablative and non-ablative laser procedures in patients currently on or recently finished with isotretinoin. The exceptions they kept were the deep ones: mechanical dermabrasion and full-face ablative resurfacing still carry the six-month recommendation.
So “six months for everything” is a rule a lot of the profession is still repeating past its evidence. That said, and this is the part that matters more for an esthetician in Canada, none of it changes who gets to make the call. Isotretinoin is prescribed and monitored by a physician, your insurer has its own view, and treating recently-medicated skin on your own judgment is exactly the scenario a professional liability claim is built from. The right move is to ask, document the answer with a date, and route anything within the window back to the prescriber for clearance in writing.
Ask about the rest of the medication list in the same breath: blood thinners and anticoagulants, immunosuppressants, hormonal treatments, anything that photosensitises. And ask about supplements, because fish oil and high-dose vitamin E behave like blood thinners and nobody volunteers them.
6. “When your skin is injured, does the mark stay dark or heal flat?”
That’s the Fitzpatrick question in disguise, and it gets a better answer than asking it straight. Ask a client to place herself on a six-point scale and you’ll get a guess. Ask her what happened the last time she had a spot, a scratch, or a burn, and whether the mark stayed brown for months, and you get her actual post-inflammatory hyperpigmentation risk, which is the thing Fitzpatrick was a proxy for in the first place. Follow with how she tans and burns in the sun, and whether anyone in her family has melasma.
PIH risk changes settings and depths more than almost anything else on the intake, and getting it wrong is expensive in a way clients notice. Hyperpigmentation from an over-aggressive treatment can take months to resolve, and it happens on the client’s face. Our chemical peel calculator, microneedling depth calculator, and laser hair removal calculator all key off skin type for exactly this reason. The same protocol is a different risk profile on a type II than on a type V.
While you’re here, ask about scarring: keloids, hypertrophic scars, or a history of cold sores, which matters for anything that traumatises the perioral area.
7. “What does a good result look like to you?”
This is where a consultation stops being a history and starts being a business conversation, and it’s the question that prevents the most refund requests.
Ask it plainly, and then push once for specifics: not “clearer skin” but what she’d be able to see, and when she’d expect to see it. What you’re testing for is the gap between what she wants and what the treatment does, because that gap is the entire source of dissatisfaction. A client who expects a single facial to clear cystic acne is going to be unhappy with a technically perfect facial.
There’s a second reason to take the answer seriously. Body dysmorphic disorder is meaningfully more common in the rooms we work in than in the general population: a systematic review and meta-analysis in Aesthetic Plastic Surgery put the prevalence at 12.65% among dermatology patients and 15.04% among plastic surgery patients, against roughly 2% in the general population. You’re not diagnosing anyone, and you shouldn’t try. But the pattern worth recognising is a client fixated on a flaw you can barely see, distressed out of proportion to it, who has had the same concern treated repeatedly without ever being satisfied. That’s a client the treatment will not help, and the kindest and safest answer is to decline and suggest she speak to her physician.
For everyone else, the useful move here is to say the honest version out loud: what this treatment will do, what it won’t, and how many sessions it realistically takes. Some clients will book less than they intended to. Those are also the clients who come back.
8. “What’s your budget and how much downtime can you take?”
Ask both in the same breath. Most estheticians skip them because they feel rude, and they aren’t. They’re the difference between a treatment plan a client can actually complete and one she abandons after session two.
Downtime gets skipped more often than budget does, which is backwards. A client with a wedding in three weeks or a job where she’s on camera has a hard constraint, and a plan that ignores it will get cancelled, not adjusted. Ask what’s in her calendar over the next month before you recommend a series.
Budget works better as a range and a rhythm than as a number. “Would you rather do one deeper session or a series of lighter ones over three months?” gets you the same information without asking anyone to state a figure out loud, and it lets you build a plan she’ll finish.
Then close the loop while she’s still in the chair. The rebooking numbers in this industry are stark. Clients who leave with the next appointment already booked retain at roughly 70%, against about 30% for the ones who say they’ll book online later. And the consultation is the moment when the reason for that next appointment is most obvious to both of you. Our guide to running a profitable esthetics business in Canada works through the rest of that math, and booking deposits in esthetics covers what to do about the ones who book and don’t arrive.
9. “Anything changed since last time?”
For returning clients this is the whole consultation compressed into four words, and it’s the one most often replaced with a greeting and a comment about the weather.
Medications change. Pregnancies happen. Someone starts tretinoin in November and books a peel in December without connecting the two. An intake form completed in 2024 and never revisited is a snapshot of a client who no longer exists, and “she filled out a form once” is a weak position if a reaction ever ends up in front of your insurer.
Make it a prompt that appears in the chart rather than a habit you rely on, and give it three specific hooks so it doesn’t collect a reflexive “nope”: new medications, new skincare, and anything that’s happened to her skin since you last saw her. Thirty seconds, every visit.
10. “Can you tell me what you’re going to do at home for the next two weeks?”
End by making the client say the aftercare back to you. This one comes straight out of clinical practice, and the evidence behind it is unambiguous. Between 40% and 80% of medical information is forgotten immediately, and close to half of what people do retain is retained incorrectly. That’s the finding from Kessels’ review in the Journal of the Royal Society of Medicine, and there’s no reason to think aftercare instructions delivered at the end of a relaxing facial fare any better.
The fix is called teach-back, it’s recommended by AHRQ and the Institute for Healthcare Improvement as a basic health-literacy practice, and it costs about forty seconds. Instead of asking “does that make sense?”, which everyone answers yes to, ask her to tell you the plan in her own words. Then correct whatever comes back wrong, which will be more than you expect.
Frame it as your problem, not a test: “I want to make sure I explained this properly. What’s the plan for tonight and tomorrow?” Send the written version by email or text afterwards, because the spoken version is decaying from the moment she stands up.
Where the answers go
Ten good questions produce a lot of information, and information that isn’t recorded didn’t happen. That’s the practical failure point in most skin practices. Not the asking, but the fact that the answers live in someone’s memory until the end of the day and arrive in the chart as “consult done, discussed options.”
For a consultation to be worth running, two things have to be true afterwards. The answers have to end up in one place, attached to the client, retrievable when she comes back in eight months. And the medical ones have to be structured rather than buried in prose, because “no retinoids for two weeks prior” is only useful if you can see it at a glance next time. Under Canadian privacy law that record isn’t optional either: PIPEDA applies to a one-room studio the same way it applies to a clinic, and BC, Alberta, and Quebec run their own private-sector laws on top of it.
The friction is real, though. Nobody wants to conduct a consultation from behind a laptop, and the alternative, writing it up between clients or at nine at night with six charts open, is how the detail gets lost. The tax is bigger than it feels: a time-and-motion study in Annals of Internal Medicine found clinicians spending nearly two hours on documentation for every hour of direct patient contact.
How Zdrovia helps with skin consultations
Zdrovia is practice software for Canadian estheticians and clinics, and the piece built for exactly this problem is the AI Scribe: it writes the consultation note for you, while you’re still looking at the client.
You hit record and leave the laptop shut. It transcribes live, and when you’re done it proposes the chart note in front of you:
- Your headings, your template. The prose lands in the consultation form you already use, not a generic one.
- The medical answers as fields, not prose. Fitzpatrick type, isotretinoin date, retinoid interval, pregnancy status, allergies — said out loud once, filed where you can see them at a glance in eight months instead of rereading a paragraph.
- Nothing saved without your tick. Every proposal is a checkbox you accept or reject. Anything the client never mentioned stays empty rather than being guessed at.
- Audio is never stored. It’s transcribed and discarded, and the record it leaves behind is the kind PIPEDA expects you to keep.
That’s the half of a consultation you can’t fix with better questions. Question one only works if you’re not typing through the six seconds. Question nine only works if last visit’s answers are somewhere you can find them. And “consult done, discussed options” is not a defence if a reaction ever lands in front of your insurer.
The AI Scribe is free on every Zdrovia account while it’s in beta. Book a walkthrough and we’ll run a skin consultation through it using your own intake form.
The short version
Print this, tape it inside a cupboard door, and run it in order:
- What made you book this, specifically? Then stay quiet for six seconds.
- What are you using on your skin right now, morning and night?
- What treatments have you had, when, and how did your skin respond?
- Any chance you’re pregnant or breastfeeding?
- Isotretinoin, ever? When did you finish? Plus medications and supplements.
- When your skin is injured, does it stay dark or heal flat?
- What does a good result look like to you, and by when?
- What’s your budget, and how much downtime can you take?
- Returning client: anything changed since last time?
- Tell me what you’re going to do at home for the next two weeks.
If I had to keep only two of those, I’d keep the second and the tenth. What she’s putting on her face at home is where most of your complications come from, and whether she can repeat the aftercare back to you decides whether the treatment you just performed survives contact with her bathroom cabinet. The rest is a very good history.
Ask them properly, and the only work left is writing it down. Book a walkthrough of Zdrovia and see what a consultation looks like when the note writes itself while you’re still talking.