Pre-Treatment
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Consents/Pictures
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Skin Assessment
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Area 1
• • •
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Treatment #
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Area 2
• • •
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Treatment #
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Area 3
• • •
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Treatment #
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Area 4
• • •
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Treatment #
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Treatment Settings
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Area#1
• • •
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Other Treatment Zone
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Energy
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Pulse Width
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CutOff Temp
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Total Treatment Time
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Area#2
• • •
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Other Treatment Zone
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Energy
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Pulse Width
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CutOff Temp
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Total Treatment Time
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Area#3
• • •
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Other Treatment Zone
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Energy
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Pulse Width
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CutOff Temp
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Total Treatment Time
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Area#4
• • •
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Other Treatment Zone
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Energy
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Pulse Width
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CutOff Temp
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Total Treatment Time
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Treatment Summary
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Total Treatment Time For Entire Treatment
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Treatment Response
• • •
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Patient Education
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Treatment Area
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Staff to Complete Procedure
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