MA7D1 – VTCT (ITEC) Level 7 Diploma in Clinical Aesthetic InjectableTreatments

Learner's Full Name

First NameLast Name

Modality Demonstrated

Supervisor's Name

First NameLast Name

Date

"I declare that the work submitted in this portfolio is my own"

LEARNER - Procedure description & Reflection

Please elaborate your reflection to include: ● Confidence in delivering the treatments ● Communication with the patients ● Consultation skills: including medical history check, planning, assesment, managing expectations aftercare instructions ● Treatment planning ● Anatomy knowledge ● Skin preparation ● Injection technique ● Product selection and amount of units or volumes used ● Patient safety ● Aseptic technique ● Aftercare Instructions

Patient initials

Pre and post photography taken?

Supervisor declaration for botulinum toxin/dermal filler

I confirm that the learner has:

Supervisor declaration for range of dermal filler
For this case study I confirm the learner has completed (please select)

1. Gender:

2. Essential Areas

3. Desirable Areas

4. Techniques

5. Assess presenting factors

6. Equipment used

Supervisor declaration for range of botulinum toxin

For this case study I confirm the learner has completed (please select)

Gender:

2. Essential areas

3. Desirable areas

4. Techniques

5. Assess presenting factors

Supervisor's Feedback

Please provide a detailed feedback including ● Learner's confidence levels and knowledge ● Clinical reasoning. ● Anatomy knowledge . ● product selection + Units or volumes used. ● Communication with the patient. ● Preparation and treatment process. ● Technical challenges encountered. ● What went well. ● Areas for improvement before the next patient.

Learner's Signature

Supervisor's Signature

Date

Supervisor's Name

First NameLast Name

MA7D1 - LEVEL 7 MENTORSHIP DAY FORM