|
Technician
|
Skin Type
|
|
Treatment Area
|
Treatment Number
|
|
Pregnant?
|
Sun exposure since last treatment?
|
|
Changes in Medical History?
|
Changes in Medical History
|
|
Changes in Medication?
|
Change in Medication
|
|
Complications since last treatment
|
Complications
|
|
Photos Taken?
|
Post-op form to patient?
|
|
Photos
|
|
|
|
|
|
Area Treated
|
Wavelength or Program
|
|
Temp C Sun Mode Snowflake
|
Spot Size mm
|
|
Fluence J/cm2
|
Pulse Width ms
|
|
Rep Rate HZ
|
# of pulses
|
|
|
Reaction
|
|
Area Treated
|
Wavelength or Program
|
|
Temp C Sun Mode Snowflake
|
Spot Size mm
|
|
Fluence J/cm2
|
Pulse Width ms
|
|
Rep Rate HZ
|
# of pulses
|
|
|
Reaction
|
|
Area Treated
|
Wavelength or Program
|
|
Temp C Sun Mode Snowflake
|
Spot Size mm
|
|
Fluence J/cm2
|
Pulse Width ms
|
|
Rep Rate HZ
|
# of pulses
|
|
|
Reaction
|
|
Area Treated
|
Wavelength or Program
|
|
Temp C Sun Mode Snowflake
|
Spot Size mm
|
|
Fluence J/cm2
|
Pulse Width ms
|
|
Rep Rate HZ
|
# of pulses
|
|
|
Reaction
|
|
Clinician Signature
|
|
