DIAMOND GLOW TREATMENT LOG
First Name
*
Last Name
*
Email
*
Patient email on file
Type a question
*
Treatment #
Combined with other Services
Date
Area Treated
Solutions Used
Diamind Tip Grit
Suction Power
Add Ons
Neck
Face
Eyes
Lips
.
NOTES
Provider Name
*
Provider Signature
*
Clear
Date
*
/
Month
/
Day
Year
Date
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