brevaAesthetic consultation
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: [ ]