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Cosmetic Dermatology Treatment Progress Chart

Patient Treatment Documentation and Monitoring Form

Dermatology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _______________ Date of Birth: _______________ Chart Number: _______________

Treatment Area Documentation

Pre-Treatment Assessment

Treatment area(s): □ Face □ Neck □ Hands □ Other: _______________
Current skin condition: _______________
Photos taken: □ Yes □ No
Fitzpatrick skin type: □ I □ II □ III □ IV □ V □ VI

Treatment Details

Session Information

Date	Treatment Type	Settings Used	Provider

Post-Treatment Observations

Immediate response: □ Mild □ Moderate □ Significant
Side effects: □ None □ Erythema □ Edema □ Other: _______________

Progress Tracking

Treatment Goals

Primary goal: _______________
Secondary goals: _______________

Results Assessment

Follow-up Date	Improvement %	Patient Satisfaction	Notes

Patient Satisfaction Survey

Scale: 1 (Not Satisfied) to 5 (Highly Satisfied)

Overall results: □ 1 □ 2 □ 3 □ 4 □ 5
Treatment comfort: □ 1 □ 2 □ 3 □ 4 □ 5
Would recommend: □ Yes □ No

Notes

This document is part of your medical record and helps track your cosmetic treatment progress.

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