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ALEX/YAG Window Replacement Form
Your Name
*
Clinic
*
Amarillo
El Paso
Midland
Lubbock
Corpus Christi
Date Replaced
*
🛈
+
Type of Window Replaced
*
-
YAG - 12mm
ALEX - 12mm
ALEX - Slider Window
YAG - Slider Window
GMax Pro Slider
GMax Pro Handpiece
# of WINDOWS REPLACED
*
# of WINDOWS LEFT in Inventory
*
Pulse Count
*
LVM Screen Photo (for pulse count)
*
Picture of Dirty Window (The one being replaced)
*
🛈
Notes (if any)
Reminder
-
Keep the Used Window in the Box Labelled 'Used Windows' in the Supply Room