IPL TREATMENT LOG
First Name
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Last Name
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Email
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Patient email on file
Treatment Log
Treatment #
Treatment Area
Laser Used
Pulse Duration MS
Fluency j/cm2
Pulse Train
Cooling
Post Treatment Care Discussed
1
2
3
4
5
6
7
Date
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/
Month
/
Day
Year
Date
Post Treatment Care Discussed
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Provider Name
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Provider Signature
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Date
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Month
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Day
Year
Date
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