Laser Treatment Progress Monitoring Chart

Patient Self-Assessment and Treatment Response Tracker

Dermatology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________________ Treatment Start Date: //___ Procedure Type: _________________________

Treatment Sessions

Session Log

Date Session # Provider

Symptom Assessment Scale (Rate 0-10)

Pain/Discomfort

  • Pre-treatment: ___
  • 24 hours post: ___
  • 48 hours post: ___
  • 1 week post: ___

Redness

  • None (0) → Severe (10)
  • Immediate post: ___
  • 24 hours: ___
  • 48 hours: ___
  • 1 week: ___

Swelling

  • None (0) → Severe (10)
  • Immediate post: ___
  • 24 hours: ___
  • 48 hours: ___
  • 1 week: ___

Treatment Response

Improvement Scale

  • □ 0-25% improvement
  • □ 26-50% improvement
  • □ 51-75% improvement
  • □ 76-100% improvement

Side Effects (Check if present)

  • □ Blistering
  • □ Crusting
  • □ Hyperpigmentation
  • □ Hypopigmentation
  • □ Other: ____________

Post-Treatment Care Compliance

  • Sunscreen used daily: □ Yes □ No
  • Moisturizer applied: □ Yes □ No
  • Avoided sun exposure: □ Yes □ No
  • Followed aftercare instructions: □ Yes □ No

Notes




Next Appointment

Date: //___ Time: : AM/PM

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