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Pre-Treatment Screen
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Check all that apply.
• • •
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Patient Denies
• • •
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Numbing
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Settings
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Treatment Area #1
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Area(s)
• • •
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Tip
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Energy
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Mode
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Depth
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Passes
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Repetition
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Treatment Area #2
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Area
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Tip
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Energy
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Mode
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Depth
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Passes
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Repetition
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Treatment Area #3
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Area(s)
• • •
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Tip
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Energy
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Mode
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Depth
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Passes
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Repetition
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Treatment Area #4
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Area(s)
• • •
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Tip
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Energy
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Mode
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Depth
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Passes
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Repetition
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Post Treatment
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Check all that apply.
• • •
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Additional Notes
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