Appointment Log

Patient Appointment Log

Clinic

Language Team Member

Date

Time

Patient First Name

Patient Last Name

Procedure

Patient Condition

Medication & Treatment Plan

Are there any additional appointments?

Yes

No

Future Appointment Information

Did the patient make any payments today?

Yes

No

In order for us to share the full payment information with the patient via email later today, we require the full payment breakdown.

Ex:

Procedure List w/ Price Breakdown:

– Hair Transplant: 7,200,000krw

– Serum: 800,000krw

Total:

– 8,000,000krw

Deposit (this should have been shared with you in advance):

– 800,000krw

Today’s Payment Amount(s):
– 7,200,000krw

Procedure List w/ Price Breakdown

Total

Deposit (if any)

Today’s Payment Amount(s)