Aesthetic consultation
United States | Cosmetics & aesthetics

Blank documentation outlines for US practice. Adapt to the encounter and your practice requirements; complete only findings and care actually documented.

ENCOUNTER
Patient name: [ ]
Date of birth: [ ]
Date and time of encounter: [ ]
Clinician: [ ]

GOALS AND HISTORY
Patient concerns, goals and expectations: [ ]
Prior cosmetic treatments, products, dates and response: [ ]
Relevant medical history, medications, allergies and risk factors assessed: [ ]

ASSESSMENT
Areas examined and baseline findings: [ ]
Photographs and consent if obtained: [ ]
Suitability assessment and reasons to defer if applicable: [ ]

DISCUSSION AND PLAN
Options, expected outcomes, limitations, risks and alternatives discussed: [ ]
Product and indication discussed, including off-label use if applicable: [ ]
Patient questions, preferences and decision: [ ]
Planned treatment or decision to defer: [ ]
Follow-up plan: [ ]