Ficha Tecnicas de Spa

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FICHA TÉCNICAS DE SPA

PROTOCOLO DE: ________________________________________________

Fecha: __________________________

DATOS PERSONALES
Nombre completo: ________________________________________________________
c.c___________________________ Fecha de nacimiento: _________________________
Dirección: ____________________________ Barrio: ___________________
Teléfono: _______________________ Edad: ____________ Ocupación: _________________________
PATOLOGIAS CUTANEAS
Eritemas___ varices___ vasodilatación___ hiperhidrosis___ otros_______________________
ALERGIAS
Si___ no___ ¿cuál?___________________________________________
Observaciones:______________________________________________________________________
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Recomendaciones_____________________________________________________________________
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_______________________ _____________________
Firma del paciente firma de la estudiante de estética
c.c___________________ c.c 1116281386

Protocolo a seguir de: ___________________________________________________


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