Treatment Record Treatment Record TREATMENT DATE * TREATMENT TYPE * CLIENT NAME * CLIENT NAME First First Last Last CLIENT EMAIL * CLIENT PHONE * KNOWN CONTRAINDICATIONS * CHANGES TO MEDICATIONS * Details FACIAL DEVICES/MODALITIES PRODUCTS USED CLINICAL PEEL DEVICES/MODALITIES PREP SOLUTION PEEL TYPE NUMBER OF PASSES / TIME ON SKIN ENHANCERS FINISHING PRODUCTS MICRONEEDLING NUMBING CREAM Prescription BLT Numbmaster None FOREHEAD EYE AREA / TEMPLES NOSE UPPER CHEEKS LOWER CHEEKS UPPER LIP CHIN UNDER JAW NECK DÉCOLLETÉ LASH & BROW TREATMENT TYPE Lash Lift Brow Lamination Lash Lift / Brow Lam Combo Brow Wax Lip Wax Chin Wax Cheek Wax Nose Wax Full Face Wax Lash Tint Brow Tint Lash/Brow Tint Brow Wax + Brow Tint Brow Wax + Lash/Brow Tint Brow/Lip/Chin Wax Trio PRODUCTS USED ADDITIONAL TREATMENT NOTES PROVIDER SIGNATURE * signature keyboard Clear Date Submit If you are human, leave this field blank.