Appointment Check-Out Form
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- Body Contouring (General)
- Body Cavitation
- Laser Lipolysis
- CoolSculpting
- EMSculpt
- Pressotherapy
- Advanced Facial Treatments (General)
- Microneedling
- Microdermabration
- Dermaplaning
- Chemical Peel
- LED Light Therapy
- Cryo Facial
- PRP / PRF Facial
- HydraFacial
- Deep Cleansing Facial
- Hair Loss Restoration (Non-injectable)
- Hair Loss Restoration (Injectable)
- Topical Exosome
- Botox
- Xeomin
- Jeuveau
- Dermal Fillers
- IM Shots
- IV Drip
- PRP / PRF Body
- Hair Removal Laser
- CO2 Laser
- Pico Laser
- Erbium Ablative Laser
- Erbium Fractional Laser
- IPL Photofacial
- Laser Tattoo Removal
- Laser Vein Removal
- Consultation
- Other
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- Abdomen – Upper
- Abdomen – Lower
- Ankles
- Arms – Upper
- Arms – Lower
- Bra Line – Front
- Bra Line – Back
- Back – Upper
- Back – Mid
- Back – Lower
- Bikini Line – Standard
- Bikini – Extended
- Brazilian – Full
- Buttocks – Upper
- Buttocks – Lower
- Calves
- Chest
- Feet / Toes
- Hands
- Hips
- Knees
- Thighs – Inner
- Thighs – Outer
- Thighs – Back
- Thighs – Front
- Underarms / Axilla
- Waist / Sides (Flanks / Love Handles)
- Face – Full
- Face – Lower (Perioral / Jawline)
- Face – Cheeks
- Face – Sideburns
- Upper Lip
- Chin
- Jawline / Beard Area
- Neck – Front
- Neck – Back
- Nape / Hairline
- Full Body
- Other (Specify in Notes)
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- Upper Face – Horizontal Lines
- Upper Face – Between Brows (Frown Lines / “11s”)
- Upper Face – Eyebrow Lift
- Upper Face – Crow’s Feet (Sides of Eyes)
- Upper Face – Bunny Lines (Sides of Nose)
- Mid / Lower Face – Nasolabial Area (Smile Fold Support)
- Mid / Lower Face – Gummy Smile
- Mid / Lower Face – Lip Lines (Smoker Lines)
- Mid / Lower Face – Lip Flip (Upper Lip)
- Mid / Lower Face – Corners of Mouth (Downturned Corners)
- Mid / Lower Face – Chin (Dimples / Orange Peel)
- Mid / Lower Face – Jawline Slimming / Masseter
- Neck & Lower – Neck Bands (Platysmal Bands)
- Neck & Lower – Necklace Lines (Horizontal Neck Lines)
- Neck & Lower – Décolletage (Chest Lines)
- Functional / Other – TMJ / Jaw Tension (Masseter)
- Functional / Other – Migraine / Headache Treatment
- Functional / Other – Excessive Sweating – Underarms
- Functional / Other – Excessive Sweating – Hands
- Functional / Other – Excessive Sweating – Feet
- Functional / Other – Other (Specify in Notes)
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- Cash
- Card
- Cherry (Payment Plan)
- PatientFi (Payment Plan)
- Affirm (Payment Plan)
- Check
- Wire Transfer
- Reward Points
- Other
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TerribleLOVED!
- Gia
- Sophia
- Alan
- Eden
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This section includes what the patient reports, such as their symptoms, feelings, and medical history.
This section contains observable and measurable data, including vital signs, physical exam findings, lab results, and other diagnostic data.
Provide your professional interpretation of the subjective and objective information, which can include a diagnosis or a list of potential diagnoses.
This part outlines the next steps for the patient, such as treatment recommendations, orders for further tests or procedures, and instructions for follow-up care.
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