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Consents/Intake/HIPPA reviewed in square
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Fitzpatrick Questionnaire
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What is the color of your eyes?
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What is the natural color of your hair?
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What is the color of your skin?
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Do you have freckles?
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How does your skin respond in the sun?
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Does your skin tan?
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How deeply do you tan?
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How does your face react to the sun?
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When did you last expose your body to sun?
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How often do you expose the area to be treated to the sun?
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Add up total score
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Type
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Laser Settings
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Face
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Area
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Treatment Area
• • •
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Session Type
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Energy level
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