Templates · Free template · Neurotoxin charting
Botox Face Chart Template
A printable neurotoxin treatment record with a blank face chart for marking injection points, a units-by-area table, and the product, reconstitution, lot, and follow-up details a complete injectable record needs.
What a neurotoxin record needs
The record should let another injector reproduce, or deliberately change, what you did. That means the product brand (units are not interchangeable between brands), how it was reconstituted, the lot number and expiry, the units given in each area, and where the injection points were placed. The face chart is the fastest way to record placement; the table is where the numbers live.
Record the patient's baseline and follow-up with photos taken in the same lighting and position, and note any asymmetry you saw before treating. Most patients return at around two weeks for review, and the review is far more useful when the original record is specific.
Why the lot number matters
If a product lot is ever recalled or a supplier issues a safety notice, you need to identify which patients received it quickly and with certainty. That is only possible if the lot is recorded against the patient at the time of treatment, not reconstructed later from purchase invoices.
Neurotoxin Treatment Record
Visit
Pre-treatment
- Consent reviewed and signed
- Medical history and medications reviewed
- Pregnancy / breastfeeding status confirmed
- Prior neurotoxin treatment and response reviewed
- Baseline photos taken
- Skin cleansed
Product
Injection points
Mark each injection point and the units given there.
Units by area
| Area | Units | No. of points | Notes |
|---|---|---|---|
| Glabella | |||
| Forehead | |||
| Crow's feet — left | |||
| Crow's feet — right | |||
| Bunny lines | |||
| Chin | |||
| Masseter — left | |||
| Masseter — right | |||
| Other | |||
| Total |
After treatment
- Aftercare instructions given
- Two-week review booked
Sign-off
Template from zdrovia.ca/templates/botox-face-chart-template/ · Adapt to your college's documentation standard before use.
Chart it once, find it every visit after
Zdrovia comes with starter chart templates for aesthetics, including a neurotoxin treatment record and a laser session record, and you can adapt any of them to match this one. Fill the chart on a tablet during the treatment, or let the AI Scribe complete it from what you say out loud. Products and lots dispensed from inventory land on the same patient record, and photos attach to the visit. Free for solo practitioners, with data stored in Canada.
See how Zdrovia is set up for med spas.
Frequently asked questions
What is a Botox face chart?
A blank diagram of the face used to mark where neurotoxin was injected and how many units went into each point. Paired with a units-by-area table, it gives the next injector a precise record of the previous treatment.
How many units of Botox are used in each area?
Dosing is a clinical decision that depends on the product, the patient's anatomy and muscle strength, and their goals. This template deliberately leaves it blank. Our Botox unit calculator shows the published ranges by area as a reference.
Should I record reconstitution on every chart?
Yes. The volume of diluent determines how many units are in each 0.1 mL, so recording it makes the units column verifiable and lets another injector interpret the record correctly.
Related
This template is a documentation aid, not clinical guidance. It records decisions about dosing, depth, and settings; it doesn't make them. Documentation standards vary by province and profession, so adapt it to your regulatory college's requirements.