PICO LASER TREATMENT LOG
First Name
*
Last Name
*
Email
*
Patient email on file
Date
*
/
Month
/
Day
Year
Date
Laser Facial Treatment Log
*
Treatment #
Treatment Area
Laser Used
Pulse Duration MS
Fluency j/cm2
HTZ
Cooling
1
2
3
4
5
6
7
Provider Name
*
Provider Signature
*
Date
*
/
Month
/
Day
Year
Date
Preview PDF
Submit
Should be Empty: