Technician
*
Patient
*
Pre-Treatment Checklist
Recent Sun Exposure?
Yes
No
Comments
New medications since last treatment?
Yes
No
Comments
Self Tanner / Spray Tan in last 7 days?
Yes
No
Comments
Pregnant / Breastfeeding?
Yes
No
Comments
Improvement from last treatment?
Yes
No
Comments
Test spot performed?
Yes
No
Comments
Safety eyewear applied?
Yes
No
Comments
*
Sunscreen applied?
Yes
No
Satisfied with treatment?
Yes
No
Next treatment scheduled?
Yes
No
Notes
Patient Signature
*
Date
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Month
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Day
Year
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