IPL TREATMENT LOG
First Name
*
Last Name
*
Email
*
Patient email on file
Date
*
/
Month
/
Day
Year
Date
Treatment Log
Treatment #
Treatment Area
Laser Used
Pulse Duration MS
Fluency j/om2
HTZ
Cooling
1
2
3
4
5
6
7
Provider Name
*
Provider Signature
*
Date
*
/
Month
/
Day
Year
Date
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