FOLLOW-UP EVALUATION

Client Name: ____________________________ Date: ______________________

Technician Name: _______________________

1. Has your medical history changed since your first treatment? Yes No

If yes, please explain: _____________________________________________

___________________________________________________________________

2. Has the treated area been exposed to tanning/sunlight since your last

treatment? If yes, please explain: __________________________________

____________________________________________________________________

3. During your first visit, was the treatment procedure explained to you? Yes No

4. Do you understand what to expect during the treatment process? Yes No

Do you have any questions at this time? ____________________________

___________________________________________________________________

5. After your treatment, did you use any lotions, moisturizers or sprays? Yes No

If yes, please describe: _____________________________________________

6. Describe your first treatment: How did it feel on a scale from 1-5?

1) No Pain (Didn’t Feel a Thing) 4) Moderate (Painful, Need Topical)

2) Mild (Slight Snap) 5) Intolerable (Had to Stop)

3) Tolerable (Some Pain, but Okay)

7. Was that what you expected? Yes No

8. Did you notice any negative side effects after the treatment? Yes No

a. Redness Yes No Duration: _________________________

b. Swelling Yes No Duration: _________________________

c. Bruising Yes No Duration: _________________________

d. Crusting Yes No Duration: _________________________

e. Blistering Yes No Duration: _________________________

f. Skin color change Yes No Duration: _________________________

g. Other: ___________________________________________________________

9. Did you notice hair fall-out? Yes No

a. How long did it take before you noticed anything? _________________

b. How long was the amount of hair reduced before it began growing? __________________

10. Were you comfortable during the treatment? Yes No

a. What can we do to make it more comfortable for you? ______________

______________________________________________________________________

b. Would you be interested in using a topical anesthetic? Yes No

* This form is to be completed before each subsequent treatment begins. This form does not need to be completed before the first treatment.