Free Aesthetic Office Visit Report Template
Aesthetic Office Visit Report
I. Patient Information
|
Patient Name: |
[Your Name] |
|
Age: |
35 |
|
Contact Information: |
222 555 777 | [Your Email] |
II. Visit Date and Time
|
Visit Date: |
October 12, 2050 |
|
Visit Time: |
2:00 PM |
III. Reason for Visit
[Your Name] visited the clinic seeking treatments for facial wrinkles and overall skin rejuvenation. She expressed interest in non-surgical options and specific recommendations for anti-aging solutions.
IV. Treatment Details
A. Botox Injection
|
Treatment Area |
Units Injected |
Outcome |
|---|---|---|
|
Forehead |
20 Units |
Reduction of fine lines and wrinkles |
|
Glabellar Lines |
15 Units |
The smoother appearance between the eyebrows |
B. Dermal Fillers
|
Injection Site |
Quantity |
Product Used |
Outcome |
|---|---|---|---|
|
Nasolabial Folds |
1 ml |
Juvederm Ultra |
Fuller, more youthful appearance |
|
Lips |
0.5 ml |
Restylane |
Enhanced lip volume |
V. Medical Notes
[Your Name] is in overall good health. She has no known allergies to any products used during the visit. It was noted that he expressed a low threshold for discomfort, so a topical anesthetic was applied before the filler treatments. No adverse reactions were observed during the procedure.
VI. Recommendations
The following recommendations were made to [Your Name] for follow-up care and maintaining the results of his treatments:
-
Avoid strenuous exercise and alcohol for 24 hours following the treatment.
-
Stay upright and avoid lying down for the first 4 hours post-treatment.
-
Use a gentle facial moisturizer suitable for post-procedural care.
-
Apply sunscreen daily to protect the skin and maintain results.
For best results, [Your Name] was advised to consider a maintenance schedule for Botox every 3-4 months and fillers annually or as needed.
VII. Next Appointment
|
Next Appointment Date: |
January 15, 2051 |
|
Time: |
2:00 PM |
The purpose of the next appointment will be to evaluate the results of the current treatments and discuss any additional aesthetic concerns or desired enhancements.
