Templates · Free template · Injectables
Deoxycholic Acid (Kybella) Treatment Record Template
A printable record for submental fat treatments with a face diagram, the injection points and volumes placed, product and lot details, and the follow-up interval for a multi-session series.
Mark the grid and total the volume
Submental treatments are placed on a marked grid, so the record should show where. Use the diagram to mark the injection points, and record the volume per point and the total per session. Where treatment is repeated over several sessions, the running total is what keeps the series within the product's labelled limits.
Record the product and lot, the needle used, and the safety checks: the marginal mandibular nerve zone avoided, and the client's response, including swelling, bruising, and any numbness or asymmetry noted at follow-up.
Deoxycholic Acid (Kybella) Treatment Record
Visit
Pre-treatment
- Consent reviewed and signed
- Medical history and medications reviewed
- Pinch test / assessment documented
- Baseline photos taken
- Treatment area marked
Injection points
Mark the grid and injection points.
Volume
After treatment
- Expected swelling and bruising explained
- Nerve zone avoided and documented
- Aftercare instructions given
- Review booked
Sign-off
Template from zdrovia.ca/templates/kybella-treatment-record/ · 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 submental injection record include?
The product and lot, needle, number of points and volume per point, total per session and cumulative across sessions, the areas avoided, baseline photos, and the response at follow-up.
Why record cumulative volume?
Products have labelled limits per session and across a series. A running total makes it obvious when you are approaching them.
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.