Technician Healing Concern

Submitted to RMI

Today's Date *

Submitter Name *

Submitter Email *

Submitter Phone *

Technician Name *

RMI Certcode (This is the same as your TU login username, also printed on your Technician Certificate) *

Tatt2Away Center Business Name *

Tatt2Away Center Address & City *

Tatt2Away Center State or Province *

Tatt2Away Center Region (if applicable)

Tatt2Away Center Country

Client and Tattoo Description

Client Age *

Client Gender *

Client Genetic Ethnicity

Enter Clients Total KD Score *

Tattoo Location *

Tattoo Description *

Estimate date of Session Tattoo was finished on *

Provide the following contact information ONLY when the client desires direct contact with RMI.

Client Name *

Residence address & City

Residence State or Province

Residence Country

Clients Email

Client Phone Number

Instigating Treatment and Healing Concerns

Which TEPR treatment session in the planned series instigated the healing concern?

Instigating Session in Series *

Number of Tegulae Excised *

Prior Treatment Date {where applicable) *

Instigating Treatment Date *

Healing Concern Date *

Healing Concern Description *

Photographic Record

All Available photographs MUST be submitted. Photographs submitted by technicians are expected to be high quality: high resolution, in focus, and uniformly lite. Immediate PRE- and POST-treatment photographs taken during EACH treatment session are part of every TEPR protocol. At a minimum, these photographs will be available and must be submitted.

Instructions for submitting photographs and data forms.

Please change the file names from the earliest "01" to the latest to keep them in sequence before uploading.

Treatment Photos (taken by the Technician) *

Choose File

Healing Photos (taken by the Technician) *

Choose File

Healing Photos (taken by the Client) *

Choose File

Consultation and Treatment Data Forms

Upload the following Tatt2Away forms for the client and their treatment. Make sure these are copies of the SIGNED documents you scanned or photographed.

Client History and Status (CHS1, CHS2) *

Choose File

Informed Consent and Release (ICR1, ICR2) *

Choose File

Treatment Plan (TP) *

Choose File

Treatment Record (TR) *

Choose File

Technician Evaluation and Comments