Templates · Free template · Filler charting
Dermal Filler Chart Template
A printable dermal filler treatment record with a face diagram, a volume-by-area table covering lips and mid-face, product and lot details, technique, and the vascular safety checks every filler record should show.
What to record for every filler treatment
Record the product and lot for every syringe opened, the volume placed in each area, the technique (needle or cannula, and gauge), and the plane or depth where it matters. Mark entry points and treated zones on the diagram. If you are building volume over more than one visit, the running total per area is what keeps the result proportionate.
Document the safety steps too: that the patient was monitored for signs of vascular compromise, such as blanching, mottling, or unusual pain, and what you saw. Most clinics also record that hyaluronidase and an emergency protocol were available, because an insurer or college reviewer will ask.
Dermal Filler Treatment Record
Visit
Pre-treatment
- Consent reviewed and signed
- Medical history, allergies, and anticoagulants reviewed
- Previous filler (product, area, date) reviewed
- Baseline photos taken
- Topical anaesthetic applied
- Skin prepped
Treated areas
Mark entry points and treated zones.
Volume by area
| Area | Product and lot | Volume (mL) | Needle / cannula | Depth / notes |
|---|---|---|---|---|
| Lips — upper | ||||
| Lips — lower | ||||
| Lip border | ||||
| Nasolabial folds | ||||
| Marionette lines | ||||
| Cheeks | ||||
| Chin | ||||
| Jawline | ||||
| Other | ||||
| Total |
Safety and response
- Monitored for blanching, mottling, and pain during treatment
- Capillary refill normal at end of treatment
- Hyaluronidase and emergency protocol available
- Aftercare instructions given
- Review booked
Sign-off
Template from zdrovia.ca/templates/dermal-filler-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 should a lip filler chart include?
The product and lot, the volume placed in the upper lip, lower lip, and border separately, the technique and entry points, baseline and after photos, and any immediate reaction. Recording areas separately is what lets you build symmetrically over several visits.
How much filler goes in each area?
That's a clinical decision based on the patient's anatomy and goals. The template leaves it blank on purpose. Our dermal filler calculator shows typical published ranges by area as a planning reference.
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.