Pre-Treatment
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Consents/Pictures
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Skin Assessment
• • •
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Treatment #
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Vaginal Concerns
• • •
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FractoraV Treatment Settings
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Area #1
• • •
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Tip Size
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Energy
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Stacked Pulses
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Total Pulses
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FormaV Treatment Settings
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Area#1
• • •
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Energy
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CutOff Temp
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Total KJ Energy
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Total Treatment Time
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Area#2
• • •
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Energy
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CutOff Temp
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Total KJ Energy
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Total Treatment Time
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Treatment Summary
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Total KJ Energy For Entire Treatment
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Treatment Response
• • •
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Treatment Area Before
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Patient Education
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Treatment Area After
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Staff to Complete Procedure
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