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Patient is here for
• • •
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Skin Type
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Please Select
• • •
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Comments
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Area
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Tx#
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Fluence
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Spot
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other spot
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Pulses
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Chryo
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other Chryo
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Pulse Delay
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other pulse delay
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Time
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Settings
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Area
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Tx#
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Fluence
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Spot
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other spot
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Pulses
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Chryo
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other Chryo
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Pulse Delay
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other pulse delay
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Time
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Settings
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Area
|
Tx#
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Fluence
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Spot
|
other spot
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Pulses
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|
Chryo
|
other Chryo
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Pulse Delay
|
other pulse delay
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|
Time
|
Settings
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|
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|
Area
|
Tx#
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|
Fluence
|
|
|
Spot
|
other spot
|
|
Pulses
|
|
|
Chryo
|
other Chryo
|
|
Pulse Delay
|
other pulse delay
|
|
Time
|
Settings
|
|
|
|
|
Area
|
Tx#
|
|
Fluence
|
|
|
Spot
|
other spot
|
|
Pulses
|
|
|
Chryo
|
other Chryo
|
|
Pulse Delay
|
other pulse delay
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Time
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Settings
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Pre Procedure
• • •
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Other Lidocaine Applied
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Post Procedure
• • •
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Other
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Hair removal skin response
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Erythema Present
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Follicular Edema Present
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Pain tolerated
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Please Select
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Return for Tx
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Other
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Additional notes
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Tx Provider
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Initials
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