FACIAL TREATMENT RECORD CARD

CLIENT NAME: CANDIDATE NAME:

CONTRA INDICATION: YES / NO DATE:

(√) TICK IF RELEVANT TO CLIENT

CONSULTATION :
[ QUESTIONING [ VISUAL [ MANUAL [ REFERENCE TO CLIENT RECORDS

CONTRA-INDICATIONS TO STEAMING Y / N
VASCULAR SKIN DISORDERS/ RESPIRATORY PROBLEMS / CLAUSTROPHOBIA / BROKEN CAPILLARIES
/ DIABETES / LOSS OF SENSATION.

CONTRA-INDICATIONS Y/N (PREVENT TREATMENT)

IMPETIGO/ HERPES SIMPLEX / RING WORM / CONJUNCTIVITIS, SEVERE SKIN CONDITIONS /
SYSTEMATIC MEDICAL CONDITIONS / ACNE / BOILS / SCABIES / EYE INFECTIONS

MODIFICATION / RESTRICTION OF SERVICE: CUTS / ABRASIONS / BRUISING & SWELLING / RECENT

SCAR TISSUE / UNDIGNOSED LUMPS OR SWELLINGS / MILD ECZEMA / PSORISES / STYES / WATERY
EYES / VITLIGO / HYPER KERATOSIS / SKIN ALLERGIES OR OTHER:

SKIN CONDITIONS : NON INFECTIOUS CONDITIONS / PUFFINESS AROUND THE EYES /

SAGGING JAW LINE / COUPROSE SKIN / COMEDONES / OPEN PORES / BROKEN
CAPILLARIES / PASTULES / PAPULES / LINES AND WRINKLE

SKIN TYPES: NORMAL / DRY / OILY / COMBINATION / SENSITIVE / DEHYDRATED / MATURE.

NECESSARY ACTIONS
ENCOURAGING THE CLIENT TO SEEK MEDICAL ADVICE / EXPLAINING WHY THE TREATMENT CAN NOT
BE CARRIED OUT / MODIFICATION OF TREATMENT

FACIAL PRODUCTS: CLEANSER / TONER / MOISTURISER / EXFOLIATING PRODUCTS / SETTING

MASK / NON-SETTING MASK / SPECIALISED MASK

MASSAGE MEDIUM: OIL / CREAM

MASSAGE TECHNIQUES: EFFLEURAGE / PETRISSAGE / TAPOTEMENT / VIBRATIONS / FRICTION

EQUIPMENT USED: MAGNIFYING LAMP / SKIN WARMING DEVICES / CONSUMABLES

SUITABLE AFTER CARE & INTERVAL ETWEEN TREATMENT:

CLIENT SATISFIED: YES NO
[ [

CLIENT SIGNATURE ............................... THERAPIST SIGNATURE.................................

TUTOR'S FEEDBACK:

COMPETENT NOT COMPETENT [ TREATMENT DEVELOPMENT

[ [