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Cosmetic Dermatology Treatment Tracking Form

Patient Progress Documentation Sheet

Dermatology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________________ Date of Birth: //___ Chart Number: ___________________ Contact: ________________

Treatment History

Injectable Treatments

Date Product Area Treated Units Provider Notes

Laser Procedures

Date Device Settings Area Sessions Results

Skin Care Regimen

Morning Routine

  • Cleanser: ________________
  • Toner: __________________
  • Serum: __________________
  • Moisturizer: _____________
  • Sunscreen: ______________

Evening Routine

  • Cleanser: ________________
  • Treatment: _______________
  • Night Cream: _____________

Progress Photos

  • Baseline Date: //___
  • Follow-up 1: //___
  • Follow-up 2: //___

Notes & Observations

Next Appointment

Date: //___ Time: _______

Please bring this form to each appointment

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