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Pregnant?
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Accutane in the last 6 months?
|
|
Allergic to Aspirin?
|
Cold Sores in the past?
|
|
Rosacea?
|
Risks/Benefits Reviewed and questions answered
|
|
|
|
|
Baseline skin Exam
• • •
|
Comments on Baseline Examination
|
|
Confirm none of these in past week
• • •
|
|
|
Chemical Peel Done Today
|
Layers of solution placed on skin
|
|
Skin response to peel
|
Skincare products used after peel
|
|
Additional Comments:
|
|
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Follow Up
|
|
|
Skincare Recomendations
• • •
|
Skin Care Recommendations Other
|
|
|
|
|
Aesthetician/Provider
|
Post Treatment Instructions
|
|
Conversation Notes
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