LASER CLIENT RECORD 

     

    Time:

     

    PERSONAL INFORMATION

     

    Client Name: Postcode:
    Address: Mobile:
    Email: Phone (Mobile):
    Phone (Home):

    Phone (Work):

    Date of Birth: 

    Gender: 

     

    TREATMENT 

    Hair removal

    Veins

    Acne Scarring

     

    Hair Colour  

    Skin Patch Date  

    Hair Thickness

    Reaction  

    Skin Type  

    Areas to be treated:

     Client has been given Aftercare Leaflet?  

     

     

     

     

     

    LASER CLIENT RECORD

     

    No 
    Visit
    Date Medical Changes Laser Operator Yag or Alex Fluence
    J/cm2
    Pulse Width
    ms
    Repeat Rate Hz
    1
    2
    3
    4
    5
    6
    7

     

     

     

    No 
    Visit
    Spot 
    Size
    No of Shots Reactions Notes Client & Operator Initials/Name
    1

     

    2

     

    3

     

    4

     

    5

     

    6

     

    7

     

     

     

    IMPORTANT: I have been informed I MUST be clean shaven for my session or treatment cannot take place. 

     

     

     

    Client Name: 

    Date: Time:

    Client Signature:  >> Sign at document footer <<

     

     

    Therapist Name: 

    Date: Time:

    Therapist Signature:  >> Sign at document footer <<

      

    Client Signature

    Staff Signature

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