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Dermaplane or Microderm + Treatment Goal
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If other please specify
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Facial Cleanser used
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Mechanical Exfoliation Used
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Clarisonic used to clease face, and skin prepped with alcohol swab
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Light Chemical Peel Preformed
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Chemical Peel Used
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Time left on skin ___ minutes
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Was Peel Neutralized?
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Exfoliation Treatment Followed with Masque
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Masque Used
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Mechanical Exfoliation followed with Eyebrow wax
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Response
• • •
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Additional Notes
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Did any complications occurred with this treatment
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Describe the complication, and actions taken to treat it
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Additional Notes
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Follow up Recommendations
• • •
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Follow-up for what date? (mm/yy)
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