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AMERICAN LASER MED SPA

TRAINING MANUAL Tuesday, January 10, 2017 Name .

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Training Agenda Welcome & Introduction; Sales Goals & Job Expectations by Dr K HR Orientation/Accounting Orientation IT

Our Website – www.AmericanLaserMedSpa.com & eCommerce MindBody EMR Email Time-Clock / Surepayroll

D2D Operations

Work Checklists • Morning checklist • Intraday checklist • Nightly checklist • Weekly checklist • Monthly checklist

Procedure Checklist D2D Binder in detail

Detailed Clinic walk thru of each room and show what is where

Reception Desk and Reception Area Waiting Room Consult Room Treatment Room Supply Room Break Room

Supply Chain and Inventory Loss Prevention – IPad, Peanut Clipper, Icepacks etc CM’s = Expense Report

Medical Didactic ELOS online learning modules Dr K’s presentation (below) Hands on Getting to know the Machine and the Tx room

Equip – Front/back/heads/buttons Equip – Cleaning – daily, weekly, monthly Equip – Maintenance Equip - Problems & repairs

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Tx Chair & Utility Cart Room – Rest of the room – what’s where etc Laser Safety – Goggles, Sign on door; OSHA – sharps container

Hands on Mesopen Hands on Ultrasonic

Sales and Customer Service

1. Consult Powerpoints 2. Sales Word document 3. QRG – 7 steps 4. Ecommerce = Price List 5. Online Quote Sheet = customize to their budget 6. How to process Sale online 7. Mindbody - contact log with follow up sequence 8. Role Play – Consult 9. Role Play – Upsells 10. Live Shadow

Upsells 1. Pre-Procedure (EMR & MB) Review = and create Wish List/Quote

sheet – (proc/$/pmt plan) 2. Intra-Procedure (In-person) Review = step 2 thru 5 3. Follow up. Follow up. Follow up. = in person, phone, email

Always plant seeds = contact log, sales forecast, sales ticket Follow up sequence with contact log in MB

4. Get Referrals 5. Get Testimonials

Marketing Intro to 4 types of marketing we do Table to explain all 4 (Referrals, Internet, Outbound, Misc) Role play on what to do with Yodle and Signature Specialist emails and phone calls Role play on Phone skills (inbound inquiry) Role play on entering leads into MB and starting follow up sequence – From inbound phone calls, from Yodle, from Scheduler 3 times a day

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Welcome to Training! Training Links- http://alcteam.weebly.com/training.html Introduction – http://alcteam.weebly.com/training---introduction.html American Laser Med Spa is a group of 6 clinics in Texas and New Mexico. We specialize in non-surgical, non-ablative cosmetic laser procedures. Primarily we do Laser Hair removal, Mesopen for skin Rejuvenation and wrinkle reduction on the face and Coolsculpting for fat reduction (thighs, buttocks and abdomen). In addition to laser procedures, we do Ultrasonic, Botox, Dermal filler injections. We offer the following services: 1. Laser Hair Removal 2. Mesopen 3. Zeltiq 4. Ultrasonic Facials = a high end, medical grade, non-laser facials 5. Cosmetic injections = Botox and Dermal Fillers (Juvederm Ultra Plus XC) Your training consists of 5 parts. You must successfully complete all 5.

1. HR Orientation 2. IT 3. Day-to-Day Operations 4. Medical 5. Sales

Our MISSION is simple = Transform Lives by making people feel Young, Beautiful & Confident & Build a Community Make People happy by providing - 1. Excellent Medical service (give them their money’s worth!) 2. Excellent customer service (create raving fans!) Generate Revenue by 1. Sales thru - Consults and Upsales 2. Understanding ALL marketing ideas – eg Friends & Family Referral program, Upsells, Testimonials etc. Medical Training consists of 1. Didactic = eLearning & Dr Kanase’s didactic training and taking the tests 2. Hands on training by Medical Trainer Happy Learning!

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INTRODUCTION BY DR KANASE & SALES GOALS / JOB EXPECTATIONS - SEE POWERPOINT (online - under Training Section) Core Values

1. Tell the Truth 2. Obsess over Customers

• Be Passionate • Results count – NO excuses • Retail is detail

3. Educate & Learn Always 4. Focus - Do one thing & do it well 5. Innovate 6. Think Long Term 7. Be Humble

Mission Transform Lives by making people Feel Young, Beautiful & Confident & Build a Community Goal

• Be the Undisputed Cosmetic Laser Authority in our Market • Help People have Beautiful Skin & be Hair Free

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HR ORIENTATION

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Revised 7-31-2015 HR ORIENTATION Dress Code / Rules of Conduct Welcome to ALMS, we are glad to have you on our team, but just so you know We always have passive recruiting so don’t be offended if you see your job posted online!

HR Orientation The first 90 days is a probationary period, you will be considered “part time”. At the end of 90 days, you will be evaluated by your supervisor and signed off on for successfully completing training. You will then be considered a full time employee. Once you are full time, you are eligible for benefits such as PTO and insurance. A full time employee must work at least 36 hours per week, 72 hours per pay period to receive benefits- PTO, vacation, and insurance

• Timeclock Use – For All Employees & For Managers • Attendance Policy • Paid & Unpaid Time Off • OT Prevention & Correction • Payroll • SurePayroll - How to use it • Dress Code • Rules of Conduct Optimizing schedule – NEED VIDEO - Dr K to discuss then finalize Staff Schedule - NEED VIDEO - Dr K to discuss then finalize

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Benefits Health Insurance (Medical/Dental/Vision) Life Insurance 401K Credit Corrections Program Smart Dollar - Dave Ramsey Program

Pay Time Offs – Vacation, PFP, Volunteer Hours Reimbursement Scrubs & Shoes Reimbursement Free Treatments

TIMECLOCK USE - No buddy punching (grounds for immediate termination) Buddy punching is: Using someone else’s log in and password to clock them in or out when they are NOT in the clinic. Know how to clock in, clock out, lunch in-out. Always check for OT everyday Know how to put notes in time clock No tardiness CM’s must clock out for lunch Over Time Prevention & Correction Guidelines (see Intranet)

“OT Prevention” – know how to check your hrs daily Managers – how to correct tech time clock errors All Employees including salaried employees are required to clock in and out every day. All full time employees are required to clock in and out for lunch EVERYDAY. You may not clock in at any location other than the clinic you are working at. The time clock is web based and it audits the punches to 1/100th of a second and notes the IP address where you are clocking in from. Violating this rule will lead to immediate termination Managers- If you leave the clinic for business reasons you must get approval from the regional manager, so we will know where you are. You do not need to clock out. If you leave the clinic for personal reasons - you must get approval from the regional manager first, and you must clock out.

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ATTENDANCE POLICY – Background

When you are Absent/Tardy, it causes significant problems in the clinic. Sales, Service (Treatments) and Customer Service, all 3 suffer!! Your Colleagues (Techs, CM's & Corporate Staff) suffer Tech Clients/Patients suffer because you are not there to perform treatments. Phone calls and follow ups that you were supposed to do are not done. Pts sometimes have to be rescheduled due to work overload. THIS IS NOT OKAY Your colleagues suffer as they have to take on your work load. THIS IS NOT OKAY CM Patients and your Colleagues suffer (as above) Sales suffer due to = Consults rescheduled or being done by tech Corporate communication and activities suffer DEFINITIONS – Absent – Not at work for Whole day Unscheduled/Unplanned & NOT Preapproved absence for the whole day. Eg Sick, car wreck, Family sick etc Tardy – Not at work for part of the day Came in late OR left early for a scheduled shift OR left in the middle of the day OR took Longer Lunch that was not preapproved (>1hr) If you clock in after 9:00am you are late. 9:01 am is considered late. You must make notes in the time clock why you were late. Your manager may ask you to come in 15 minutes before 9 am. This is to ensure that you are prepared for your 9 am patients.

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Consequences for Violation of PTO policy Beginning December 1, 2013 we will implement the following to reduce the amount of violations of the attendance policy. Occurrence Absent=Consequence Tardy=Consequence

1 VerbalAdvisement VerbalAdvisement

2WrittenWarning+1daysuspension+30dayprobation WrittenWarning

33Daysuspension+another30dayprobation

writtenwarning+1daysuspension+30dayprobation

4 Termination3dsuspension+another30dayprobation

5 NA Termination

How Will You Make Up For Lost Time - Tech (Hourly Employees) - At the CM's discretion. CM will discuss with Reg Manager and finalize. Either of the 2 choices below will apply - You will be required to come in on your day off (without incurring OT) OR We will just let it be (at company discretion) Work More will mean cover at least 1/2 a day shift i.e. 4 hrs. You CANNOT make up lost time by working 'extra hours' each day CM / Reg Manager (Salaried Employees) - At your Supervisor's Discretion (Reg Mgr or Corporate). Either of the 2 choices below will apply - You will be required to come in on your day off OR Take a Pay Cut (furlough) Work More will mean cover at least 1/2 a day shift i.e. 4 hrs. You CANNOT make up lost time by working 'extra hours' each day or by working from home

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Notifying Tardy/Absent = eg Calling in Sick etc Who to Notify Notify your Clinic Manager- before your shift. If you cannot reach your Manager - contact your Regional Manager If you cannot reach your Regional Manager – contact HR If you cannot reach HR – Contact Dr K (only as absolute last option!) How to Notify your supervisor - Call, Leave a voice mail, Send a text, Send an email - whatever you have to do to make sure you’ve made contact with someone. You must receive confirmation or acknowledgement of your call in for it to count. Otherwise you will be considered a no call no show and can be terminated. Absent (sick) for 3 days in a row – Need a Dr’s Note If you are Absent (sick) for 3 consecutive days, upon returning to work you must bring a note from a Physician stating the nature of your illness.

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Paid & Unpaid Time Off Refer to Section 5.2 and 5.3 of the Employee Handbook Time Off Requests-

There is a time off request form on the Intranet. You need to fill this out to request any time off. You must receive approval from Corporate after the request is sent.

5.2 Paid Time Off Full-time employees of the Company will be provided paid time away from work. These are -

1. Holiday 2. Vacation 3. PTO – pay for performance (need details) 4. Volunteer Hours (need details)

1. HOLIDAYS Full time employees worked for at least 90 days are eligible. Employees in the following categories are eligible to receive holiday pay:

• Exempt (salaried) employees who have worked for the Company for at least 3 months.

• Nonexempt (hourly) employees who are classified as regular full-time employees and have worked for the Company for at least 3 months

Day Date

New Year's Day Monday, January 02, 2012 Memorial Day Monday, May 27, 2013 Independence Day Thursday, July 04, 2013 Labor Day Monday, September 02, 2013 Thanksgiving Day Thursday, November 28, 2013 Christmas Day Wednesday, December 25, 2013 New Year's Day Wednesday, January 01, 2014 These are the 6 paid holidays in a year. You will be eligible for paid holidays after 90 days on the job as Full time employee. The following conditions apply to the Company's holiday pay policy:

• Holiday pay will not be considered as time worked for the purpose of overtime calculations.

• Holiday pay is computed at individual employee's base rate of pay. • Holidays will not be paid to employees on any type of unpaid leave. • Holidays falling within an approved scheduled vacation will be recorded

as holiday pay. • Employee must be present at work on his or her last scheduled day

prior to the holiday and the first scheduled day after the holiday to receive holiday pay.

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2. VACATIONS Fill out the Time Off Request Form on Intranet, to request time off. You may only take up to max 5 straight days at a time. Full-time employees will receive the following paid days. 2nd year (& beyond) begins after the first anniversary of date of employment and so on.

1st Year 0 Days 2nd Year 5 Days 3rd Year 10 Days 4th Year 10 Days 5th Year 15 Days

• Maximum 5 straight days at a time • Only 5 days per quarter • Use it or Lose it - Vacations must be used the year they are earned—

they cannot be “carried over” to subsequent years. • 45 Days Advance Approval Required

Apply for vacation request at least 45 days in advance before taking a vacation. This ensures the clinic is adequately staffed to cover for your absence. Corporate is responsible for approving or denying requests. Requests for vacation days off without sufficient notice will be denied. Vacation /time off requests cannot be made retroactively after taking time off.

You may request to use a PTO day, but you may not take any vacation days before your first year of employment. Terminated employees who provide a written, 2-week notice are eligible to receive any vacation time earned from their last anniversary date, but not yet taken. Payment for unused vacation will be forfeited if:

• Less than a two-week notice is given, • a two-week notice is given but the departing employee violates work

standards and policies during the two weeks, • The employee does not work out the entire 2 weeks’ notice, or • The employee is terminated for misconduct.

IMPORTANT – Written Warnings are noted as ‘Misconduct’ in your HR records 3. PTO – pay for performance (need details) You earn paid time based on a pay for performance. Paid Pay-for-Performance day before/after Vacation or Holiday – Not to exceed 5 consecutive days off 4. Volunteer Hours (need details) Volunteer Hours (need details)

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5.3 Unpaid Time Off

These are -

1. Bereavement Leave 2. Jury Duty 3. Military Leave 4. Voting Leave

Where the needs of business allow or applicable state and/or federal law requires, employees may be given unpaid leaves of absence for Bereavement leave, Jury duty, Military duty and Voting. a. Bereavement Leave You will be entitled to take bereavement leave in the event of the death of an immediate family member, domestic partner, or grandparent, in accordance with applicable law. Immediate family is: father, mother, wife, husband, son, daughter, brother, sister, mother-in-law, and father-in-law. Requests for special consideration for particular circumstances should be directed to your Clinic Manager or your immediate Supervisor. You may take up to 3 days off for immediate family and 1 day off for others. These days are unpaid by the company, however, you may use personal days (PTO) if you are eligible. b. Military Leave An unpaid leave of absence will be approved for employees who are members of active or reserve military service and are called to duty, in accordance with the provisions of the Universal Military Training and Service Act, the Uniformed Services Employment and Reemployment Rights Act, and any applicable state law, statute or ordinance. This includes both field training and emergency duty. Reinstatement of the employee after completion of service will be conducted in accordance with federal and state law. To request military leave, a copy of orders, specifying date and duration of duty, must be submitted to your Clinic Manager/Supervisor or to the Human Resources Department. Employees taking a military leave may utilize accrued but unused vacation time for a portion of the military leave, unless otherwise required by law. c. Voting Leave The Company encourages its employees to vote in every election. The Company will comply with all federal and state laws in that respect. Employees should try to vote prior to or following normal work hours.

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OT Prevention & Correction Over Time Prevention Guidelines –

In order to optimize labor costs and budget – we must have ZERO OT

Techs – Check your hours for the week daily (morning and evening) when you clock in and clock out. Keep a running total for the week based on an 8 hr day. If you work more than 8 hrs that day – let CM know so she will adjust your work schedule next day by taking a longer lunch or another break.

DO NOT come in late or leave early for the day to prevent OT.

Be especially careful for the week where you are working 5 days.

When you check on a daily basis, you can easily adjust and correct well in advance.

Do not wait till the last day of the work week i.e. Tuesday am to make adjustments. It’s too late by then. CM’s – Check work hours for ALL techs in the clinic. Same as above.

Check daily (morning and evening).

To Adjust Work Schedule –

• Take longer lunch break or another break during the day

• DO NOT come in late or leave early for the day

• When in doubt or if you need help – contact Regional Manager/HR

OT Correction Guidelines –

If an employee does end up working overtime, he/she will work commensurate less hours next week to compensate

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Payroll Surepayroll –

You will receive an email to the email you provided on your application before your first paycheck with information on how to register and log in to your account. You will need to be sure and log in and verify that all information is correct.

Employees get paid every 2 weeks on Fri thru electronic direct deposit into their bank account.

• Access your paystubs and your W2 etc thru SurePayroll • Always check for accuracy - On every Payroll Friday am • If there are mistakes, notify HR immediately • We want to make sure you get paid for your work

Any changes (more or less money) will not be made until the next paycheck

• Our Payperiod runs from Wednesdays to Tuesday of the following week.

• Payroll is processed every other Wednesday, if you need to make a change of any kind, tell HR BEFORE Wednesday of the payday week.

• Please always verify your time clock is correct so there is no mistake on pay day.

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Dress Code We want to project a professional image representing we are the industry leader. Our industry is one of luxury, advanced technology & medicine. Show proper etiquette and professionalism. Remember, the higher we hold our standards on all levels the more confidence our clients will have in our abilities. Below are very specific requirements for your professional appearance while you are at work or representing our company. Clinic Managers – Business casual Techs – Scrubs in black or blue

Scrubs You are required to purchase scrubs and shoes but will be reimbursed $200 at 1 year employment anniversary. You are required to • purchase 1st set of scrubs immediately (within 30 days employment) • purchase 2nd set of scrubs & Shoes (at 60 days employment) Color of scrubs = Black or Blue. All personnel performing procedures should wear matching or coordinating scrubs as purchased thru Life Uniforms. Scrubs should be free of wrinkles, frayed edges and clean with no stains. When the new employee comes to training in Amarillo the first order of Black Scrubs will be sent to Life Uniforms Store in Albuquerque Email store162@scrubsandbeyond.com Information need is-

• Location- They have our mailing address for all 6 locations • Full name of employee- • Position- Laser Tech, Manager/Laser Tech, Sales, etc.…. • Top size- • Bottom size- • Color-

Once confirmed that the employee did receive the scrubs, payroll deduction will be setup: one payment of $72.12 or two payments of $36.06 The 2nd Set of Scrubs (blue) MUST be purchased by Day 60

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Life Uniform Contact person - Alicia or Maria Scrubs & Beyond, LLC 5001 Montgomery Blvd. NE, Suite A-21-C | Albuquerque, NM 87109 Phone: 505-881-7877 | Fax: 505-881-0025 http://www.scrubsandbeyond.com/Brands-Greys-Anatomy-Scrubs.html (TOP)

http://www.scrubsandbeyond.com/Greys-Anatomy-Signature-Callie-3-pocket-low-rise-cargo-scrub-pant-136282.html (BOTTOM)

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Shoes This is an OSHA requirement. Underarmor shoes (specific make and model) as required by the company. Closed toe shoes are a requirement of anyone who is performing a treatment. If you are a clinic manager that has to step in to perform a treatment you need to bring appropriate shoes to change into if necessary. All shoes should be clean, and neat. When an employee starts they are informed to order shoes at the 60 day mark. The new hire is required to buy their shoes at 60 days. When they purchase the shoes they need to scan the receipt and send it to HR@americanlaser-medspa.com after 1 year of service the cost of the shoe will be given back to the employee. (NOTE) shoes should cost $40-$70 (69.99 on Under Armour site) IMPORTANT - These are the only type to be purchased. No other type allowed. Contact HR if you have questions! The link for the type of shoe is under the HR links noted as Tech Shoes. http://www.finishline.com/store/product/womens-under-armour-micro-g-assert-v-running-shoes/_/A-4774?productId=prod765906 Under Armour link https://www.underarmour.com/en-us/womens-ua-micro-g-assert-v/pid1252307-449 Women's Under Armour Micro G Assert V Running Shoes

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Appearance: • No tongue rings • No nose rings • No visible tattoos • Make-up should be applied before entering the clinic. Should be

conservative and professional. Touch ups should be done off of the floor, on your restroom breaks, out of sight from patients or waiting guests.

• Hair styles and maintenance should be current and in good taste. Brash trendy colors such as hot pink, purple, green, blue and orange are not indicative of the type of image we want to portray

• Fingernails should be well groomed. Polish and acrylic overlays or tips should be professional looking not animated. French, American manicure or a color that is appropriate for work.

• Fragrance if any should be fresh or clean category. No strong fragrances. Please use good personal hygiene and deodorant.

• Breath and No Chewing Gum - Please make sure your breath is fresh. If you chew gum to freshen your breath after lunch, make sure to dispose of it before entering the clinic. Popping, clicking or blowing bubbles with chewing gum at work is ill mannered, and prohibited.

• SMOKERS - NO SMOKE SHOULD BE DETECTED ON YOUR BREATH • Jewelry should be conservative and not be in the way when doing

procedures. No facial piercings or visible tattoos. Hoop earrings should be no larger than 2” in diameter. Employees performing procedures will find it difficult to wear anything much more than a watch on the wrist area.

• No Jeans - Jeans are never to be worn in the clinic. Any exception must be approved by the regional manager.

• If you have a doubt about what you’re wearing may not be suitable, make another choice.

You may speak to HR Dept. if you have any questions or doubts about an article of clothing. NO PERSONAL CELL PHONE USE AT WORK No Personal Facebook LOL’s and OMG’s!! Phone etiquette:

• Smile when you answer the phone-they can hear it in your voice • Be energetic when calling to confirm consults • Always identify yourself to the caller – “American Laser Med Spa, this

is (Name), how may I help you.” Please do not say “can I help you?” • Answer their questions thoroughly – always educate • Don’t just try to ‘sell’ over the phone

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Rules of Conduct 1. Dress code – Read the 2 page dress code 2. Notebook - Everyone must have their ‘Notebook’ – to take notes 3. No Tardiness/Leaving Early. Come in on time 9:01am is considered

late. You should be in clinic at least 15 minutes early to prepare for the day. You should not leave until after all work is done. You cannot leave early without Regional Manager’s approval

4. No Food or Drinks at the front desk, in consult room, in treatment rooms. Food or drink only in the break room

5. No personal cell phone use. No cell phones on clinic floor and ringers off. Make personal calls when you are not out in the clinic.

6. No surfing the internet. No personal Facebook etc 7. Ask for permission before leaving for any reason during the day

that is not lunch. Even if you leave for lunch, please let someone know where you are.

8. Act and behave like a Professional. No personal, derogatory language towards other staff in front of patients

9. Treat patients with Respect. No belittling comments 10. DO NOT abandon pts. Eg going to lunch while your pt is waiting. 11. If it’s in your ability to treat a patient, whether or not they are

someone else’s patient, (and as long as the patient is fine with it), you should always do so. Our patients come first!

Time Management skills -

• Plan your day at the beginning and at the end of the day – 1st and Last 15 min are crucial for good work flow.

• Plan your work and work out your plan • Prioritize. Focus on what’s most important for the day. The rest can

wait • Follow up Calls – Make follow up sales calls. 80% businesses don’t call

after 1st no-sale. When in reality 80% prospects buy after 5th to 12th interaction. Use Mindbody dashboard and contact log to help you with this.

Problem Solving Skills – • Think thru for a solution not just the problem – be a PPS (professional

problem solver) • Do not panic • Do not give unauthorized Discounts without prior permission from the

regional manager or Dr Kanase. Will be discussed in Sales trg as well • Do not give unauthorized Procedures without prior permission from

Regional Manager or Dr Kanase. Any unpaid treatment MUST have a WRITTEN authorization. Will be discussed in Sales trg as well.

• Anything regarding Money, always in writing

• Anything regarding HR, always in writing

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Communication –

• Contact Log for pts should be filled out for every interaction with a pts whether it be Email or Text or Call

• If you have not heard back – send 2ND REMINDER email / Text • Always follow up or Double Check - to ensure work is completed • Phone skills – see D2D ops also for phone skills

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ACCOUNTING ORIENTATION Income

Processing sale in eCommerce Expense

Petty Cash & Expense report – get written authorization before use Misc

Mail coming to the clinic Mailing Envelope to Corporate – Monthly checklist

INCOME How to Process Check – When a customer wants to pay by check, first ask if they have a debit card instead, if they do – proceed like a credit card transaction. If they do not have a debit card, follow these steps. We DO NOT ACCEPT CASH – ask for a credit or debit card. They can go to Walmart, Target etc and convert the cash into a gift card so we can process payment electronically.

EXPENSE Petty Cash & Expense Reports- We do not keep petty cash. Managers are responsible for small expenses (usually no more than $20) & will be reimbursed via expense report. Expense report must be filed online. See expense report procedure for reimbursement. IMP – Reimbursement will not be made if receipts are missing Reimbursement will not be made if proof of authorization is missing IF MONEY IS MISSING IT WILL COME OUT OF YOUR PAYCHECK!!

• Petty cash is used for minor expenses • DO NOT purchase anything without first getting a written approval • Keep copy of receipts. You won’t be reimbursed if you do not have

receipts AND written proof of approval. Eg

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You need to purchase paper towels. Send email to Dr K. He will reply saying “approved”. Print this email. Go purchase the item. Save the receipt. Before the 5th of the month complete the expense report for the last month as follows. Expense Reports The expense report form online consists of 3 types of attachments:

1. The excel sheet 2. Copy of Receipts for every purchase 3. Proof of Approval for every purchase

1. Expense Report Excel Sheet Write a brief explanation next to each item. The name of the excel sheet is “Expense Report Reimbursement Form” 2. Copy of Receipts Make a copy of all your receipts, scan and upload it with the expense report form online. No exceptions. Reimbursement will not be made if receipts are missing 3. Proof of Approval for every purchase All purchases must be approved in advance – send Dr K an email, he will reply approved - print that email, scan and upload it with the expense report form online. All purchases must have proof of approval via email. Verbal approval is not acceptable. If for some reason approval is given verbally, there needs to be an email from Dr K for paper trail. By making sure it is in writing, you are protecting yourself in case of future auditing about the purchase. No exceptions. Reimbursement will not be made if proof of authorization is missing Fill Expense Reports Form online (on Intranet) before the 5th of each month. Upload the 2 attachments with it - • Upload the Expense Report Excel sheet • Upload Copy of Receipts and Proof of approval Accounting will audit the expense report and issue reimbursement on payroll or by check sent to the Clinic Manager to be cashed.

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IT TRAINING

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IT TRAINING • Our Website www.AmericanLaser-MedSpa.com & eCommerce • Website - Intranet • Mindbody • MB app on your phone • EMR – also done in Medical training • Patient Pad • Listen360 • Email • Timeclock • Surepayroll

OUR WEBSITE – navigate ALL pages INTRANET WEBSITE – navigate ALL pages MINDBODY

• Adds herself as employee = Login and password. Work only under your login

• Adds herself as a client = account profile, online store, visit-schedule-payment history, Check out Online store, Help section (videos etc)

• Download and use MB app on her cell-phone – as employee BASIC STEPS How to Add New Client How to ‘look up’ old clients/prospects How to check Profile for 100% accuracy PROFILE –

Active Vs Prospect email address, mobile provider, email and text, Ref code, prospecting stages, billing information V.IMP points – email, mobile provider, Ref Code and Prospect Stage, Rep, Client Index Lookup and Add New clients (active, inactive etc) Contact log Follow up sequence (see document library) Always have a contact log

Looking up another client later OR ‘cleaning up’ Profile Especially update client Index and Staff alerts HOME PAGE for client DASHBOARD

Create and save 2 Reports 1. Sales by Rep report - daily & monthly accrual 2. Pts Not Checked out = ‘Arrived’ Report – from Sch @ Glance

Mindbody Reports >>Sales >>Sales (again) >> Make sure the date is correct (usually today’s date)

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Check - All Categories; All Reps; All Payment Methods; Include autopays; All Employees, Detail and Cash Basis Click Generate >> Export the report to pdf (click the icon) How to lookup your contact logs daily (especially ‘red’ overdues) for f/u sequence FINANCIAL MODULE

Retail – sell products and services (FF is under contract and packages), How to setup Autopay Every time you make a sale, always check the ‘Sales by Rep’ Report to make sure you get credit for it Create sales ticket How to check-out as ‘comp/guest’ after finishing Tx Who are ‘comp guest and why?

SALES MODULE

Update Prospect stage Create Contact log with follow up sequence – see document library Create Sales Forecast How to look for Ref codes (also see ‘Profile’) SCHEDULING

Book ‘Recurrent’ appointments – do ‘add ons’ after each appn individually Book a single appointment Override tx time – ‘add on’ other procedure for same time slot Booked - Confirmed – arrived - Check in – check out Reschedule – cancel – no show – late cancel

V.IMP – check in / check out consults correctly Schedule at a glance, appn view, Room view. REPORTS

Reports – how to read several reports Sales, Sales by Rep, Forecast, Contact log etc.

INVENTORY

How to update Inventory (see Weekly check list excel file)

Reports - Create video / Ricardo to train

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DAY TO DAY OPERATIONS

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DAY TO DAY OPERATIONS TRAINING Goal – To know what I am supposed to do from the moment I walk in the Clinic to the moment I leave the Clinic everyday. Detailed guidelines for daily, weekly, monthly activities Quick Revision of

• Do I know what is expected of me – page 7 • Rules of Conduct including Dress Code – page 15

Assign Clients - You will be assigned clients in MB as Rep on file Same list for EMR

1. Checklists - i. Pre-Intra-Post Procedure Checklist – see Medical

ii. Daily = Morning, Nightly & Intraday Checklist iii. Weekly (Monday morning) checklist iv. Monthly Checklist

2. Optimizing Schedule & OT Guidelines – see document library

3. Follow Up Sequence – see document library

Binders -

1. D2D Binder – a. Checklist – Morning/Intraday/Nightly = on Lt side of binder b. Staff Schedule c. Checklists – Weekly and Monthly d. Optimizing Schedule & OT Guidelines e. f/u sequence guidelines f. Supply & Inventory Section– Inventory sheet, PO’s,

Equipment maintenance log eg water change, calibration g. Accounting – Expense, Misc

2. Medical – 1 ring binder. Everything else online Clinic walk-thru of each room and show what is where Reception desk Reception area & Waiting room Consult Room Treatment Rooms Supply Room Employee Break Room Mock walk thru as if you are a pt (new and established) Equipment Pulse count, Maintenance and Repairs (Every Mon morning checklist) also see Medical Training

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Supply chain and Inventory (See Supply Chain Clinic Procedure Manual & Monday morning check list) How to stock the Tx rooms (Utility cart & Refrigerator) How to stock the Medical Supply Shelves How to stock Office and Marketing supplies How to stock and do inventory on paper – Inventory sheet How to log inventory-on-hand in MB (every Monday morning)

How to Order supplies How to Receive supplies What to do when you have not received supplies after ordering

Phone System –

See Gliffy Diagram – Flow of Phone system on Document Library How to check clinic phone VM

OTHER D2D ITEMS - Expense Report and Petty Cash Procedure How to scan documents - and email / upload to documents in MB Loss Prevention – Ensuring items do not get lost/stolen/broken

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CHECKLISTS - Morning - Check the schedule and plan your day (including lunch breaks) – 1st 15 min Night - Check the schedule and Recap your day – last 15 min MORNING CHECKLIST (BEGINNING OF THE DAY) See excel file named ‘Checklist’ in document library>Morning Goal – Know how many People you are going to Make Happy today! Focus on Every single patient, every single time Focus on % improvement – EMR = % improvement–Skin Type–Correct Settings & Technique

• How many Treatments today • How many Consults today • Sales forecast for the day (Consults, and TRU – Testimonials,

Referrals, Upsells) • F/U sequence • Customer Service issues to address

Clinic Managers When you complete the morning checklist you should be able to answer - I know how many consults I have and my sales forecast for the day I know who I need to call to f/u I know all other Admin stuff that I need to complete Techs When you complete the morning checklist you should be able to answer -

• I know who I am treating and for what • I know who I need to call and for what (TRU – see

Dashboard>Contact logs)

Your activity includes (the 1st 2 are the most important) 1. Treating patients 2. Making Phone calls – sales and customer service 3. Charting (documenting treatments in EMR) 4. New Projects – eg f/u sequences updating 5. Other Misc stuff – answering phones, taking messages, cleaning

DO NOT abandon pts. Eg going to lunch while your pt is waiting INTRADAY CHECKLISTS NIGHTLY CHECKLIST (END OF DAY) WEEKLY (Monday Morning) CHECKLIST MONTHLY (1st day of the month) CHECKLIST (See excel file named ‘Checklist’ in document library > Monthly)

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PHONE SKILLS Guidelines for handling phone calls (inbound and outbound) Phone etiquette:

• Smile when you answer the phone-they can hear it in your voice • Be energetic when calling to confirm consults • Always identify yourself to the caller – “American Laser, this is Adela,

how may I help you.” Do not say “can I help you?” • Answer their questions thoroughly – always educate • Don’t just try to ‘sell’ over the phone

Types of Phone calls –

• Medical calls • Sales calls • Customer service • Scheduling • Misc

Customer Complaints - tell them to go to the website and fill out online form OR you fill out the form Refunds – tell them to go to the website and fill out online form OR you fill out the form Account Balances – No Payment-No Treatment. Collect money before tx. Setup autopay if needed Transfer Patients – Only between our 6 locations. Tell them to contact Amarillo Corporate office

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Mail - Incoming Mail to the clinic -

• Open incoming mail daily • If it looks Important > Scan & email Accounting Dept immediately • Mail Originals to Corporate Before the 5th of each month (See Monthly

checklist)

Mailing Packet to Corporate (Monthly checklist) – Before the 5th of each month, mail the envelope containing the following –

• Mail - (originals of) letters etc received in the clinic. No need to send junk mail. If you’re not sure, include it.

• Expense Related – your original purchase receipts from expense report

Send it via Regular Mail to (DO NOT FedEx or overnight it) –

American Laser Med Spa PO Box 51623 Amarillo, TX 79159

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Medical

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Medical Overview and program outline Didactic Consult PowerPoints Online learning modules – coolnet.com, ELOS, New Candela-Syneron website Course Presentation (below) Patient Pad – Pt Intake History & Consents EMR – Pt Medical Records MB – Relevant information eg Contact logs & Documents for pictures etc Hands on Getting to know the Machine Getting the know the Treatment Room Hands on Alex & Yag Hands on Mesopen Hands on Ultrasonic Hands on Zeltiq

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Didactic - Course Presentation Focus on Results

• Immediate – no news is GOOD news >> No Pain and No Burn • Long Term - 3 weeks later (for LHR, Mesopen, Zeltiq) >> No news is

BAD news >> Need to see results when you make the follow up call How to get good results- See chart online under ‘Training’ – http://www.gliffy.com/publish/2953627/ ANATOMY

• Pic of Skin and HAIR Anatomy • Skin Assessment Form & Skin Type Chart • Settings Chart • Pain Chart & Progress Chart • Pic of Machine (Treatment head, screen, Front and Back)

Ø Epidermis, Dermis, Hypodermis Ø Hair shaft, Hair Root, Anagen-Catagen-Telogen Ø FS protocol Ø Only 10-20% hair in mature stage any given time

Why does it take multiple treatments for LHR Why does it take multiple treatments for Mesopen What can I expect by investing in this (LHR) procedure Medical – What to do when pt says it’s hurting during the procedure

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Table – Mechanism of Action Procedure Laser/Other Mechanism of Action Problem Solution LHR Light is selectively attracted to the hair and

travels down the hair shaft to the base of the hair follicle. Then, light is converted to heat and destroys the base of the hair follicle. Especially the germinal cells. Once hair follicle is permanently destroyed, hair does not re grow

Hair Laser Hair Removal

Mesopen Microneedles make ‘holes’ in the skin resulting in increased collagen

Coolsculpting

US Ultrasound waves gently exfoliate the top layer of the skin (stratum corneum). This is generally a layer of dead skin cells that cause your skin to look sallow. When this is removed, the skin becomes radiant with a youthful glow

Sallow look Radiant youthful glow to the skin

Botox Paralyses muscles which cause wrinkles on contraction

Wrinkles Temporary reduction of wrinkles

Juvederm Fills in collagen that is lost as we age Wrinkles Temp. reduction of wrinkles

Skin Tag/Mole Removal

Controlled ‘frost bite’ by decreasing temp to minus (-70)C so cells die when thawed back to body temp.

Skin tags, moles

Removal

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Table – Definitions Name Definition Selective Photothermolysis

Light (laser) is selectively attracted to a target tissue (eg hair, age spots) where it converts to heat and selectively destroys that tissue sparing the surrounding skin structures

LASER Light Amplification by Stimulated Emission of Radiation FS Protocol Follicular Sequencing

DOUBLE THE INTERVAL – just one time Once the easy hairs are destroyed the other hair follicles are scattered in their hair growth cycle. If you give a ‘resting period’ these follicles ‘talk’ to each other and sync with each other so when you fire the laser next time – you can destroy a larger number of hair follicles.

Chromophore Melanin – is the main absorbing pigment Wavelength Fluence Pulse Width/Duration TRT Thermal Relaxation Time Rep Rate Repetition Rate

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Timeframe for Results (When will I see noticeable results?) Procedure TimeFrame LHR 1 mo after 3rd Tx 6mo from 1st tx Mesopen In 1-2 weeks Zeltiq In 4 weeks US Right away Botox 7 days Juvederm Right Away

End Points

LHR

Perifollicular erythema and edema. Gen erythema subsides in 1-2min. You may not see anything at all

INSERT PICTURE

MesoPen Erythema, Pin-point bleeding

INSERT PICTURE

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Fitzpatrick scale (From Wikipedia etc) In assessing skin we use the Fitzpatrick Skin Type classification scale. This scale was developed by Dr Thomas B Fitzpatrick of Harvard Medical School in 1975. The Fitzpatrick Scale (Fitzpatrick skin typing test or Fitzpatrick phototyping scale) is a numerical classification schema for the color of skin. It was developed in 1975 by Dr T.B. Fitzpatrick, a Harvard dermatologist, as a way to classify the response of different types of skin to UV light. It remains a recognized tool for dermatologic research into the color of skin. It measures several components:

• Genetic Disposition • Reaction to Sun Exposure and • Tanning Habits

The Fitzpatrick Scale:

• Type I (scores 0-7) White; very fair; freckles. Always burns, never tans

• Type II (scores 8-16) White; fair. Usually burns, tans with difficulty

• Type III (scores 17-25) Beige; very common. Sometimes mild burn, gradually tans

• Type IV (scores 25-30) Beige with a brown tint; typical Mediterranean Caucasian skin.

Rarely burns, tans with ease • Type V (scores over 30) Dark brown.

Very rarely burns, tans very easily • Type VI Black.

Never burns, tans very easily I Always Burns Never Tans II Usually Burns Tans with difficulty III Sometimes Burns Gradually Tans IV Rarely Burns Easily Tans V Rarely Burns Very Easily Tans VI Never Burns Very Easily Tans

Online Calculator on our website skin anatomy etc – http://books.google.com/books?id=oAFSBBLU_UUC&pg=PT263&lpg=PT263&dq=lancer+ethnicity+scale&source=bl&ots=6irrMkaHcn&sig=m0Q--o4iqUzFpW_sYo4eOoQW5Cc&hl=en&ei=LA0QTub2CMHmsQLw9OWzCg&sa=X

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&oi=book_result&ct=result&resnum=7&ved=0CE4Q6AEwBg#v=onepage&q=lancer%20ethnicity%20scale&f=false Good article to help decide tx settings Use higher Fitzpatrick to be cautious http://www.nwstylist.com/columns/2010/1010/1010_esthetic_endeavors.html Robert’s skin type classification - http://findarticles.com/p/articles/mi_m0PDG/is_5_7/ai_n25494485/?tag=mantle_skin;content Lancer Ethnicity Scale How Laser Works https://www.youtube.com/watch?v=1LmcUaWuYao https://www.youtube.com/watch?v=R_QOWbkc7UI PATIENT EDUCATION – From FDA Website - http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048995.htm

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Skin Type Calculator on Website (Based on Fitzpatrick Scale) – insert here

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SKIN TYPE Chart (insert here from Website)

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TREATMENT SETTINGS – ALEX/YAG

GOAL – Hair Free in 3-4 Treatments!! DO NOT BURN PATIENTS – Burn prevention protocol supersedes everything!! PRE & POST-ICE – For Pain and Better Results SHAVE THOROUGHLY – Prevent Singing & Window Damage CLEAN TX AREA THOROUGHLY – No Makeup, Deodorant, Moisturizer

LHR ALEX/YAG Skin Type

Machine

SPOT SIZE

Tx #1 Tx #2

Tx #3

Tx #4 & Up DCD

I-II ALEX 18 18 24 30 30 30/20/0 III ALEX 18 16 20 24 30 30/20/0 IV YAG 15 36 40 48 48 30/20/0

V

YAG

15 30 38j/

30msec

38j/ 30ms

ec

38j/ 30ms

ec 30/20/0

VI YAG

18 26 28 30 Call Dr

K 30/20/0 Neck / BBE (Labia

only) ALEX 18mm 14j 30/20/0 Neck / BBE (Labia

only) YAG 18mm 24j 30/20/0 Alternate Settings If ALEX Down = I-II-III = Use YAG 40j (when returning back to your ALEX use 18/18 for Skin Type II. For Skin Type III use 18/16) If YAG Down = IV-V = Use Alex 10j Skin Type VI = NO Treatment!

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PROGRESS CHART Asking for % Improvement allows us to track the progress Compared to BEFORE you started Laser Hair Removal with us & NOW What % improvement have you noticed? Give examples

• Eg Went from shaving every day to 3 times a week = 50% improvement

• Hair is about the same but thinner – that’s the normal process. It is about 50%

• Hair is patchy – that’s normal process. It is about 30-50%

(Insert Picture)

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PAIN Pain is the best indirect indicator of potential Burn, and other complications such as scarring and discoloration (hypo/hyper pigmentation) Pain from the procedures should NOT be more than 2-3 on a scale of 10. Most patients state this as a ‘snap of a rubber band’ or warm heat sensation. “Pain will occur a little bit delayed. About 1-5 min after the laser is fired. Often times, you will not feel it right away. That means sometimes the pain on the area of treatment will be noticed a little time after the tech has done the treatment and is working on another area. eg tech is working on left underarm when you feel the pain on the right underarm” Patients have described Pain (that ended up as Burn) as -

• Burning sensation • Feeling of “My skin is on fire” • I feel heat coming from inside

Discuss PAIN LEVEL with Patients “If your pain is 4 or more on a scale of 10, please ask us to STOP the procedure. Pain scale = 1 being the least and 10 being the worst pain you have ever had.” Based on the Wong-Baker FACES Pain Rating Scale used in hospitals

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BURN PREVENTION PROTOCOL What - Pain of 4 or more on a scale of 10. This is important. Don’t just define it as snap of rubber band, curling iron etc. Be more specific on the scale When – NOT just at the time you fire a pulse but 5 MIN AFTER you fire the pulse. Often times when you are doing the other side of face or the other leg etc. At the checkout counter…or even upto 24 hrs post procedure. ASK the pt – DON’T JUST WAIT FOR HER TO TELL YOU Pre-Procedure - When in doubt Check Skin Type again Check for Tanning and other risk factors every time Ask pt to tell you if it’s pain is more than 4 during the procedure Intra–Procedure - Ask pt about pain and follow pain guidelines diligently WHEN IN DOUBT STOP!! What to do when Pt says its hurting DURING the procedure Stop > Reassess > ice 1 min > fire 1 pulse If still painful > Call Dr K DO NOT decrease the settings Potential next steps that Dr K will give you are - Abandon procedure and reschedule Continue on lower settings Ask every pt during and after the procedure – What is the pain level And document pain level in EMR

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BURN TREATMENT PROTOCOL What to do when burns happen Immediate –

• Stop • Take care of the pt (ice, Hydrocortisone cream) • Notify MD & file incident report

Ice – Burn protocol If you are concerned about a burn, immediately put ice pack on the area Keep icing until a time where pt stops complaining of burning sensation returning when the ice pack is off for atleast a min. If not, put ice pack back on again and continue till pt reports no complaints as above. This process can take from 10 min to 2 hrs Long term – Hydrocortisone cream – usually tid x 7 days Follow Physician’s directives eg schedule pt to see the Dr, Ultrasonic exfoliation etc, Continue follow up care until pt is signed off by Dr. to resume treatments If you take good care of the patient – often times they will be understanding of the fact that the procedure has risks and these adverse events may happen and not threaten to sue. They must ‘feel’ that you cared for them and address all their concerns.

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PATIENT INSTRUCTIONS FOR EMERGENCY AND FOLLOW UP CARE • If you are concerned about anything eg burning sensation on skin, blister,

increase pain etc or any other adverse events, contact the clinic immediately.

• Return to the clinic immediately for evaluation and care • After hours - If you have any concerns go to ER/Urgent care immediately. • Immediately Ice the area till the burning sensation stops • Hydrocortisone Cream – use 3 times a day for 7 days to help healing • Neosporin or Triple Antibiotic cream if needed to prevent infection • Aloe Vera or Topical Lidocaine if needed for burning sensation For Techs The best tool you have in decreasing pain and burns is HOLD THE DISTANCE GUAGE 2 SECONDS LONGER & APPLY FIRM PRESSURE Ask every pt during and after the procedure – what is the pain level? And document it in EMR

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TANNING Need details on tanning – what it is , why not tanning, dangers etc. include pictures of tanning and burns from LHR on tan skin.

Increases risk of burn

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TATTOO DO NOT Laser over the Tattoo. Keep 1 inch margin around AND Place your Hand over the Tattoo to prevent firing over Tattoo It is artificial ink (color). Will explode.

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SHAVE

• Excess hair wastes energy = Poor Results • Hair singeing = Bad Odor • Back Splatter = Damages the Machine

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CLEAN TREATMENT AREA CLEAN TX AREA THOROUGHLY – No Makeup, Deodorant, Moisturizer

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LASER SAFETY AND GOGGLES USE EYE PROTECTION - NHZ (Nominal Hazard Zone) & MPE (Maximum Permissible Exposure) Proper wavelength OD filter Goggles –

• DO NOT use them like your sunglasses • DO NOT put them on your forehead • DO NOT remove Goggles from the Treatment Room

LHR – BOTH you and Pt will need goggles Coolsculpting, Mesopen & US – No goggles SIGN ON THE DOOR - Every LHR Room MUST have the Laser Safety Sign on the Door

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ICE PACKS AND WHY WE COOL THE SKIN Ice is your friend!! Purpose

• Cold helps decrease burn by keeping the epidermis cool • Cold helps increase efficacy of treatment because as the surface is

cold, heat stays trapped underneath in the dermis thus staying longer in the target tissue

• Cold decreases pain – it numbs the nerves and works as an anesthetic

Methods There are several different methods of cooling

• Contact cooling • DCD (dynamic cooling device) – cryogen sprays along with the laser • Air (Zimmer chiller)

We use is Contact cooling by

1. Ice pack = Remember Ice is your friend Ice pack Pre & Post Procedure protocol “pre-ice (1min)” Put ice pack for 1 min before & 1 min after every procedure for Alex and Yag DO NOT keep it longer than 1 min to prevent frostbite or cold burns DO NOT put paper towel between the skin and ice-pack Burn protocol If you are concerned about a burn, immediately put ice pack on the area Keep icing until a time where pt stops complaining of burning sensation returning when the ice pack is off for atleast a min. If not, put ice pack back on again and continue till pt reports no complaints as above. This process can take from 10 min to 2 hrs Cleaning Ice-Packs

• Baby Wipes = Use Baby Wipes in between treatments to clean ice packs for the next patient EXCEPT (see below)

• Disinfectant Wipes = moist areas eg BBE, Male – full back, chest, Legs – use Disinfectant wipes also.

• When in doubt use Disinfectant Wipes

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BLT Purpose

• Pre-procedure anesthesia How to ½ Tsp Not too much Not too little Dangers Death – Lidocaine Toxicity Or Anaphylactic Reaction Allergic Reaction If pt feels there are problems

Hydrogen Peroxide Purpose

• To Clean Mesopen Needles How to Spray after procedure. Leave it for 5 min. Gently Rinse

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STATE RULES Texas - If you are working for a Physician owned clinic, then you are exempt from the Rule below. Otherwise the following rule applies http://www.dshs.state.tx.us/radiation/laserhair.shtm LHR-Apprentice = 40 hrs training of which 24 hrs on machines etc. & CPR $50 fee LHR-Tech = performed 100 procedures in 12 months $70 fee LHR-Senior Tech = + supervised 100 procedures in 12 months. $100 fee LHR-Professional - $150 Fee New Mexico - Submit certificates to the board – get approval – then be able to do procedures. Physician must be onsite plus other rules. See NM Rules for details

RISK MANAGEMENT Good Communication and Care = No Lawsuit Burn = potential legal threat Request for Medical Records = potential legal threat

• Do not give chart right away • Notify Dr K ASAP • Within 5 business days of request - Corporate Office will mail via

Certified Return Receipt a copy of Medical Records to the Patient Medical Charting and correcting errors – 1 line strikethrough (error), initial-date and then new entry HIPPA Patient confidentiality

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Patient – Recipient of Health Care Services. Latin = patiens, patior Greek = Pashkein = One who is suffering Client – Recipient of Professional Services (rather than Goods or Products) in return for monetary or valuable considerations. Latin = cliens sponsored by Patron = patronus/padrino=godfather = Eg Professional services from Accountants, Lawyers, Architects Customer – Recipient of Goods or Products (rather than Services) in return for monetary or valuable considerations Eg – buying products in a retail store or online Used in a broader context of ‘Good Customer Service” Patron - A patron is a person or organization that supports another. Sometimes a customer is referred to as a Patron. Consumer – One who consumes (goods or products or services). Usually refers to a customer.

• We use ‘Patient’ in the context of Medical care – treatments, consents etc

• We use ‘Client’ for all other purposes eg financials, scheduling etc

• We use ‘Customer’ in the context of providing ‘Good Customer Service’.

We use these terms interchangeably to -

• Make them look & feel better and Make them happy • To give them their money’s worth

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Guidelines for Employees treating each other (even for training purposes)

• Notify and get permission from Regional Manager • Both employees must be off the clock (unless permitted for training) • Treatment must be done outside of clinic hours • Cannot interfere with paying patients • The treatment receiving employee must be treated just like any other

pt i.e. consents, charts must be accurate • Must be on MB schedule. Check out as ‘comp’ • Must have EMR / chart notes

Employees will NOT treat their relatives. Another staff member will treat them instead Role Play from time pt walks in to time pt walks out of the clinic Include the pre-intra-post procedure guidelines Pt comes in >> skin type >> correct settings Fill out Tx Record Detail Fill out Tx Record Summary (only for Paper – not for EMR!!) Review the chart Then follow Pre-Intra-Post Procedure Guidelines

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PRE-PROCEDURE QUESTIONS

Pre-Procedure Plan/Notes:

History (what pt. says)

Assessment (what you see)

Discuss PROGRESS = See CHART Discuss PAIN = See CHART Hair Type = Coarse / Fine / Mixed Are you Tan? (Have you had any sun exposure?) Y / N Y / N Any Tattoos/Permanent Make-Up? Y / N Y / N Are you Pregnant, on Accutane, or Antibiotics? Y / N Y / N Any change in Medical History since your last visit? Y / N Y / N Any change in Medications since your last visit? (including OTC) Y / N Y / N

• Tx summary, Tx Record Detail, Injectable record, ERecord Report • Charts must be completed the same day as the date of treatment.

Preferably right after the tx is done but definitely by end of the day. • IMPORTANT - Login under your name only (make sure the username is

yours, otherwise the EMR note will be recorded under someone else) • DO NOT complete charts for others – grounds for immediate

termination

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PREPARING THE CHART Every student will enter her in information in

• Pt-Pad, including ALL signed consents (just like a patient) & • Create her profile in MB – as a patient • Create her profile in EMR – as a patient

How to review a chart Patient-Pad

• Consult papers • Consents – MUST HAVE SIGNATURE ON CONSENTS

MB – Profile, contact log (also visits, schedule, purchase hx, documents) EMR - Tx Summary and the last treatment record

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CONSULT PAPERS & CONSENTS On our website. Show Patients how to access it on their cell phone Consult Papers

Demographics Reason for Visit and HPI Derm History (including cosmetic surgery and cosmetic products) Med Hx and Meds & Allergies – PCOS, seizures, skin conditions Accutane, Antibiotics (Doxycycline), Other Meds Surgical / Family / Social Hx LOC – letter of clearance – from their Physician

Consents Importance of a signed consent NO CONSENT NO TREATMENT Procedure is legally considered - Assault & Battery if we do not have consent Go Thru Details of each consent

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MB

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EMR Pre-Procedure Questions

Pre-Procedure Plan/Notes: History (what pt. says)

Assessment (what you see)

Discuss PROGRESS = See CHART Discuss PAIN = See CHART Hair Type = Coarse / Fine / Mixed Are you Tan? (Have you had any sun exposure?) Y / N Y / N Any Tattoos/Permanent Make-Up? Y / N Y / N Are you Pregnant, on Accutane, or Antibiotics? Y / N Y / N Any change in Medical History since your last visit? Y / N Y / N Any change in Medications since your last visit? (including OTC)

Y / N Y / N

• Tx summary • Tx Record Detail • ERecord Report • Charts must be completed the same day as the date of treatment.

Preferably right after the tx is done but definitely by end of the day. • IMPORTANT - Login under your name only (make sure the username is

yours, otherwise the EMR note will be recorded under someone else) • DO NOT complete charts for others – grounds for immediate

termination

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PHOTOGRAPHY PROTOCOL LHR - Before 1st Treatment & Before 6th Treatment Mesopen - Before & After Every Treatment US – Before & After Every Treatment Botox/Fillers - Before & After Each Treatment & at Day #7 All other - Before procedure & as necessary Results Photos Procedure Gender SkinType Before AfterLHR US Botox Juvederm SkinTags Moles

Burn Photos – Show Burns Pictures Folder

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HANDS ON Treat the Equipment like a Little Baby Getting to know the Machine and the Treatment Room Equip – front/back/heads/ buttons Equip – Cleaning – daily, weekly, monthly Equip - Maintenance /Problems & Repairs Utility Cart Setup Refrigerator Setup Room – Rest of the room – what’s where etc Laser Safety – Goggles, Sign on door; OSHA – sharps container Importance of a Clean Treatment room

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HANDS ON PREPARATION

• CORRECT SETTINGS • DRY RUN • MARCH

ALEX / YAG

• Care of machine – water, key & power switch, 2 ft from wall, cryo • DO NOT hold/dangle the handpiece by the fiber • Tx settings – spot size and joules • Calibration • Distance gauges • Use of laser and laser safety • Skin types • How to clean machine and distance gauges - change window every

200 pulses • Touch screen on machine - pulses, distance, joules • Dry run (mapping) • Time in tx room • Importance of pre and post icing • Turn off machine to change cryo • No makeup, moisturizer, or lotion. When in doubt baby wipe the area

How to get to the Correct Settings – Settings chart Also Ask % improvement today, Ask Hair Type today, redo skin type if needed & check EMR Tx Summary Hair singed and smells. That’s normal Pain – weird pain sensation that goes away in less than 10 sec. If there is increased pain, let us know

No Tan-No Tattoo-Shave Results –

• After 1st tx, no or minimal growth for 2 weeks. Eg go from shaving daily to weekly.

• After 2 weeks, hair regrows but frequency is still 3 times week. • Ave improvement is 30%. You will see ‘striping’ phenomenon. That is

normal. That does not mean we missed a spot. • After 2nd / 3rd tx – ave total improvement 70%

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ALEX/YAG –

• DO NOT use Distance Gauges & Windows from one to the other • They are NOT INTERCHANGEABLE • Use Alex Windows for Alex & Yag Windows for Yag • Wrong windows can DAMAGE the machine

How to do DRY RUN – Along the vertical length of the anatomic area Face = across the Forehead, Rt side of face, Lt side of face UA = vertical length Arms and Legs = vertical length Chest/Abs and Back = vertical length. Rt side then lt side Bikini area – 3 sides of triangle, front, frog leg, then on her stomach for the perineal area Treatment Technique in detail – Turn face to right or left when treating for = LHR,Mesopen,US Full body – break it into 2. Upper and lower half. LHR- U lips = have them ‘tuck it in’ so there is more surface area to treat How to MARCH March away from you Hold the DG with firm pressure. Then fire. Imp! After firing the pulse, hold the DG with Firm pressure again for 1 sec. Then move to the next pulse

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Full Body Treatment Memo

• Process Sale as Full Body In MB = Corporate will zero out Full Body treatments after sale is made AND create 6 Treatments for Upper Body and 6 Treatments for Lower Body

• MB Scheduling = Schedule Upper Body and Lower Body Treatments one day apart. Eg Monday for Upper Body & Tue for Lower Body. Repeat every 2 months (including face area)

• EMR Documentation = Record treatment done as Upper Body OR Lower Body. In notes area document areas and pulses individually as follows: For example - Upper Body documentation:

Full Face 100 pulses Neck = xxx pulses Full Arms (including Underarms) = xxx pulses Full Chest & Abdomen, Full Back = xxx pulses

Lower Body documentation: BBE = xxx pulses Buttocks = xxx pulses Full Legs = xxx pulses

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Pregnancy Memo

Pregnancy is not a true contradiction for cosmetic laser procedures that we perform. It is more of a legal than a medical issue. Approx. 8% of pregnancies miscarry and we do not want to get caught in the middle of it and end up in a lawsuit. Therefore these rules.

• After you have explained the above, if a pregnant patient is ok with continuing treatments then have her sign a special consent (need to create one online) and continue treating her. Ofcourse use common sense Eg LHR UA is ok. Be extra careful for BBE areas.

• When a patient is pregnant and wishes to continue to receive

treatments, we need a LOC - Letter of Clearance from her doctor.

• When a patient is pregnant and wishes to NOT continue to receive treatments we need a Letter from her Doctor stating the estimated due date so we can adjust the expiration date by = due date + 6 weeks.

• When a patient wishes to return to the clinic post pregnancy check for

the updated expiration date prior to scheduling.

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EQUIPMENT CLEANING - DAILY, WEEKLY, MONTHLY Alex and Yag – Daily Slider Window = Check for Cleanliness. If dirty - Replace. Fill out form Distance Gauge Windows = Check for Cleanliness. If dirty - Replace. Fill out form Weekly (Mon am) Hand Piece =

Slider Window Clean Handpiece - No kinks, No cracks, not 'dropped' etc Sliding correctly from 18mm to 15mm

Calport - Clean & Dirt Free

Backside – • Check Water level – add water to correct level • Check Vents. Vents must be Clean & Dirt Free

Electrical cord - clean and dirt free and NOT been 'rolled over' no kinks etc The Whole Body (especially the front & top) is clean IMP – Clean Vents (lint/dirt) from underneath the machine Distance Gauges & Windows - clean Goggles - Tech & Pt goggles - no cracks, clean, well maintained ALEX/YAG –

• DO NOT use distance gauges & windows from one to the other • They are NOT INTERCHANGEABLE • Use Alex Windows for Alex & Yag windows for Yag • Wrong windows can DAMAGE the machine

Mesopen The whole body is clean and no smudges Electrical cord - clean and dirt free and straighten out/no kinks US Handpiece Spatula (blade) = clean Electrical cord = clean and dirt free. Unplug the handpiece from the main machine and completely straighten out the wire before plugging it in again. Tf the wire is wounded and twisted daily, the internal wires get twisted and will fray and break. no kinks etc Body = The whole body (especially the front) is clean and no smudges

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EQUIPMENT MAINTENANCE - File Maintenance form every Monday Hand Piece =

Slider Window Clean Handpiece - No cracks, not 'dropped' etc., Fiber – no Kinks Sliding correctly from 18mm to 15mm

Calport - Clean & Dirt Free

Backside – • Check Water level – add water to correct level • Check Vents. Vents must be Clean & Dirt Free

Electrical cord - clean and dirt free and NOT been 'rolled over' no kinks etc The Whole Body (especially the front & top) is clean Calibration – Make sure it calibrates correctly Distance Gauges & Windows - clean Goggles - Tech & Pt goggles - no cracks, clean, well maintained

EQUIPMENT PROBLEMS & REPAIR - Notify Regional Manager & Dr K via text/call IMMEDIATELY File equipment problem form Call equipment technician – to troubleshoot Call Corporate Operations to Coordinate Repair Tech comes onsite to Repair If equipment needs to be shipped (ultrasonic) - Arrange / Coordinate shipping Get an ETA for Repaired Machine to be back to you Cancel/Reschedule pts for the # of days that the machine is out Once the machine is Repaired - Make sure it is working properly

File equipment problem form for paper trail saying received in good working condition Notify Regional Manager & Dr K via text /email Call Pts that need to be ‘caught up’ due to missed days

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Guidelines for Treating Patients MEDICAL LHR Pre-Procedure (from the time they enter the clinic till the laser is fired) Consent and Consult Papers = Patient fills consult papers & signs consent (thru website) MB = Confirm in MB docs (consult papers & signed consents) MB = Click ‘Check-in’ in MB Check Progress Chart, Pain Chart & Ask Pre-Proc Questions EMR = Check EMR (Tx summary) to ensure Good Results Plan for Correct Settings and check Skin Type, FS protocol No Tan-No Tattoo-Shave & Clean Area Makeup off. Cap on (for face) Undress and drape on (for lower body) Photo – Before 1st Treatment and After series completed Pre-ice – 1 min 2 G’s = Goggles-Gloves(if needed). Mandatory – Hand sanitizer if not using gloves

Goggles on – you and patient Gloves on (for Bikini, legs etc).

Correct Settings-DRY RUN the area you are going to treat Equipment turned on and Goal for correct settings set Intra-Procedure (from firing the laser to end of firing the laser) Keep checking & asking for PAIN Place Distance Guage on Treatment area correctly Fire 2 TEST pulses. If no issues then March March = Count One-Two-Fire-One-Two. March forward - One-Two-Fire-One-Two….. Post-Procedure (from ending firing laser till they leave the clinic) Clean the treated area – Hand pt Baby Wipe Cap off and Drape off (if applicable) Gloves off (if used) Clean the machine & Clean the exam table

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Mesopen Checklist Updated 11-9-15 Pre-Procedure (from the time they enter the clinic till the Mesopen machine is turned on) Consent and Consult Papers = Patient fills consult papers & signs consent (thru website) MB = Confirm in MB docs (consult papers & signed consents) MB = Click ‘Check-in’ in MB EMR = Check EMR (Tx summary) to ensure Good Results Check % Improvement and Discuss PAIN level & Pre-proc questions asked. Ask ALLERGY to BLT Cream TANNING is OK. TATTOO = DO NOT GO OVER A TATTOO MOLES – DO NOT go over, if in doubt. Discuss Cancer risk. Ask before you go over mole. Clean Area, Makeup off. Cap on (for face) PHOTO – Before (& After) every Treatment 1 Glove on to put cream BLT Cream – ON (1/2 tsp) wait 30 min Intra-Procedure (from starting the machine to stopping the machine) Gloves on BLT cream – OFF = use paper towel 1st. then baby wipe Wipe area clean DRY RUN (Pt and you are in comfortable position) Equipment turned on and correct settings set = Speed 2. Depth 1mm/1.5mm 3 passes – Horizontal, Vertical, Diagonal Look for endpoint (Pin Point bleeding/Redness) and monitor PAIN level Post-Procedure (from stopping the machine till they leave the clinic) Clean the treated area – You clean it with Baby wipe then Hand pt a Baby Wipe OR paper towel square to clean it PHOTO – (AFTER) taken Cap off & Gloves off Remove Needle System from Machine & Clean it with Hydrogen Peroxide per protocol Needle back into inventory with pt name etc Clean the Machine and put back in supply room & Clean the Chair

% Improvement Compared to BEFORE you started Mesopen with us & NOW What % improvement in wrinkles, texture/tone of your skin have you noticed. Ex 10%, 20%, upto 100%? Discuss PAIN level – Refer to PAIN CHART DRY RUN & Procedure

1. Ensure you are Firmly Touching the skin (not too much pressure/not hovering)

2. Stay Perpendicular FLUSH to the skin 3. Back & Forth – in a Straight Line 4. Zig-Zag = ‘Snake’ like motion 5. Out to In & Top to Bottom 6. Horizontal – Vertical – Oblique except CF,Forehead = only Horizontal &

Vertical 7. 1mm = Rt-Crow’s Feet >> Lt-Crow’s Feet >> Forehead >> Nose 8. 1mm = Nose (flare the nose), put pressure on opposite side, stamping

method 9. 1.5 mm = Rt Face >> Lt Face >> Chin >> U Lip

Face – Ear (tragus) to corner of mouth for Oblique

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ULTRASONIC – Pre-Procedure (from the time they enter the clinic till the laser is fired) Consent and Consult Papers = Patient fills consult papers & signs consent (thru website) MB = Confirm in MB docs (consult papers & signed consents) MB = Click ‘Check-in’ in MB Pre-proc questions done (Tx detail and Tx summary sheet) Makeup off, cap on, chest - drape on Photo - Before 1st Treatment and After series completed NO Gloves or Goggles needed Spray water mist on face. Start from 6” away. Get good beads on face. Equipment turned on. Settings on Max for Exfoliation & Permeation Intra-Procedure (from starting the machine to stopping the machine) Turn machine ON. Press Exfoliation > Go directly to max For Permeation mode > Go directly to max Exfoliation & Permeation 3 passes per Row Use the right speed & Right Pressure Do Not Scrape or make the procedure uncomfortable Post-Procedure (from stopping the machine till they leave the clinic) US – cap off, chest drape off and dispose. Clean the machine and table (as needed)

DRY RUN & Procedure

EXFOLIATION = 1. Ensure you are Firmly Touching the skin with the ‘edge’ of the spatula (not

too much pressure/not hovering). Do Not Scrape or make the procedure uncomfortable

2. Stay at 45-degree angle to the skin. 3. Move ‘away’ from you. Eg Rt handed person. Move Rt to left the whole time 4. Move at the Right Speed = Not too fast and not too slow 5. 3 Passes Per Row = Back to Back on the same area 6. Top to Bottom 7. Forehead >> Rt Crow’s Feet & Rt Face to Nose >> Lt Crow’s Feet & Lt Face to

Nose >> Chin >> U Lip PERMEATION = 8. Ensure you are Firmly Touching the skin with the ‘flat’ portion of the edge of

spatula (not too much pressure/not hovering) 9. Stay at the same angle to ensure to Flat portion is touching at all times 10. Move ‘towards’ you. Eg Rt handed person. Move Lt to Right the whole time 11. Move at the Right Speed = Not too fast and not too slow 12. 3 Passes Back to Back on the same area 13. Forehead >> Rt Crow’s Feet & Nose to Rt Face >> Lt Crow’s Feet & Nose to

Lt Face >> Chin >> U Lip

Total procedure time approx. 5-7 minutes

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BOTOX & JUVEDERM 1. Chart Ready – confirm Injectables Consent on file 2. Patient Ready – Prepare the patient = makeup off, alcohol swab, cap on (if needed), Photo – Before & After Each Treatment & have the Tackle box in the room Post-procedure – clean the table & the room

Botox Discuss what it is, what it does etc Mock Consult and pre procedure discussion Role play Go over Injectable History and Tx record Go over Botox and Juvederm Consent Juvederm Discuss what it is, what it does etc Mock Consult and pre procedure discussion Role play Go over Injectable History and Tx record Go over Botox and Juvederm Consent

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NON – MEDICAL - Guidelines for treating patients Pre-Procedure FINANCIALS – NO PAYMENT- NO TREATMENT NO CONSENT – NO TREATMENT Red ticket on Home screen, Purchases tab, Account Details tab If they have a balance, are they current on payment? If they have a balance (RED Ticket), check Autopay Schedule under Account Details tab. If their autopay schedule is not current, they have an unpaid balance. They must pay before receiving treatment UPSELL GAMEPLAN - Check MB and EMR – MB = Follow up sequence in Contact log, sales forecast, sales ticket EMR = WISH-LIST, Happy?, Progress - % improvement MB ACCURACY - Check PROFILE, SCHEDULE, VISITS AND CONTACT LOG Update to 100% accuracy. Especially – Mobile Provider Choose from dropdown both ‘email and text’ EMAIL Birthday REF CODE Rep on file Check SCHEDULE for RECURR. APPN Pt must have all appointments scheduled thru series expiration IMP – “check-in’ pt before treatment. DO NOT take pt to Tx room unless you click ‘check-in’ (see optimizing schedule guidelines) Intra-Procedure Empathy. Get them to like you and trust you Bond with them. Discuss their problems and solutions Discuss how their treatments are coming along and are they happy EDUCATE them (on procedure and on company policies) Post-Procedure – Make pleasant small talk till they leave the clinic Check-out in MB

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Training Hands-On Protocol & Burn Probation Protocol STEP 1

• Paper Practice - Get to Correct Settings • Treatment - Small areas under Direct Supervision • Treatment – Large areas under Direct Supervision

Paper Practice – Getting to Correct Settings This tests Tech’s ability to get to the right settings even BEFORE pt comes in 100 = Write down ALL (not just yours) pts that are going to come in this month & next month for Treatment till you reach 100 Patients Write PLANNED settings CM Review = make sure Tech can get to the right settings. ZERO mistakes. Once they PASS this step move to next step IF Pass, then Treat SMALL areas UNDER Direct Supervision Treatment - Small areas under Direct Supervision 1st shadow then Treat Treat Small Area ONLY When pt is in = check Planned Settings again Tanning, % improvement & all Pre-Procedure Questions Reassess / Update Settings = GOAL settings Requires ALL of these to PASS

ZERO mistakes on getting to PLANNED & GOAL settings Discussing Pre Procedure Questions with pts Discuss Pain Chart Discuss Progress Chart = % Improvement Discuss Tanning Discussing Managing expectation with pts Discuss Post Procedure & Emergency Care guidelines Follow Procedure Checklist when performing the Treatment Proper Technique on Small area tx

In the Room Shadow Shadow 10 SMALL Treatments = CM will perform treatment and Student will observe

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Continue Planned Settings and Goal Settings & WATCH the CM doing large areas Once 10 shadows are done then Perform 30 Small Treatments under Direct Supervision Perform Treatment CM in room on ALL of the tx – to verify / monitor Proper Technique. Once passed then CM in room on only some of the tx – to verify / monitor technique After atleast 10 successful tx = PASS = Small Tx Direct Supervision Treat SMALL areas with CM in Room 10 Small = CM in Room for = ALL Treatments 10 Small = Half and Half = With CM in Room for every other Treatment 10 Small = Without CM in Room TOTAL = 30 Large Tx Requires ALL of these to PASS

ZERO mistakes on getting to PLANNED & GOAL settings Discussing Pre Procedure Questions with pts Discussing Managing expectation with pts Discuss Pain Chart and Progress Chart Discuss Post Procedure & Emergency Care guidelines Follow Procedure Checklist when performing the Treatment Proper Technique on Small area tx

IF Pass, then Treat LARGE areas without CM in Room for Treatments Treatment – Large areas under Direct Supervision 1st shadow then Treat In the Room Shadow Shadow 10 Large Treatments = CM will perform treatment and Student will observe Continue Planned Settings and Goal Settings as above & WATCH the CM doing large areas Similar to Previous step of Shadow 10 small areas Perform Treatment Treat LARGE areas with CM in Room for ALL Treatments

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IF Pass, then Treat LARGE areas without CM in Room for Treatments 10 Large CM in Room for = ALL Treatments 10 large = Half and Half = With CM in Room for every other Treatment 10 Large Without CM in Room TOTAL = 30 Large Tx Perform 10 Large Area Treatments – WITH CM IN THE ROOM for all (direct supervision). If Pass, then = Perform 10 Treatments with CM in Room for only half the treatments. If Pass, then = Perform 10 Treatment without CM in Room for a Total of 30 Large Treatments FINAL Analysis – Reassess knowledge level CM feedback to Corporate Then Consider PASS – to perform treatments independently

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SALES

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American Laser Med Spa Sales Training

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Marketing Definition – Anything done prior to their name showing in the Consult column on the scheduler. Goal – Getting someone who has a need to get to KNOW – LIKE – and TRUST you Get them to come in to see you for a free consult! This refers to generating new leads, generating new referrals from current clients etc. Sales Definition of Sales ‘Process’ - From the time their name is in the consult column to the time they come in for their 1st treatment. Goal – Close the sale. Generate Revenue. Begin the ‘transaction’

Sales

Skills

Enthusiasm

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Customer Service Definition - From the time they come in for their 1st treatment until the ‘transaction’ is complete (until they complete their package) Goal – Make them HAPPY! And of course UPSELL and generate REFERRALS and TESTIMONIALS from them. Transaction Exchange of money for services. A transaction is not complete until they have received ALL their services (eg LHR – full 2 yrs, Velashape – all 6 Tx received). So when we make a $2k LHR sale, all we have done is collected a ‘deposit’. Now we owe them good quality service. Our goal is to focus on this ‘transaction’ Lifetime Value of Customer Think of them as a customer for life. Rather than just a $2K sale for today. Our goal is to build long term relationship as their trusted friend and advisor. Sale

• Ecommerce Sale Processed (accurate Email address on file) • Received 1st treatment

Consult - Anyone NEW to the clinic (usually a prospect) Upsell - Anyone ESTABLISHED to the clinic (already a Client of the clinic) Active – Anyone who has paid (even if not received treatments) OR anyone who has received treatment (even if not paid anything) Prospect – not paid or received treatment

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Patient – Recipient of Health Care Services. Latin = patiens, patior Greek = Pashkein = One who is suffering Client – Recipient of Professional Services (rather than Goods or Products) in return for monetary or valuable considerations. Latin = cliens sponsored by Patron = patronus/padrino=godfather = Eg Professional services from Accountants, Lawyers, Architects Customer – Recipient of Goods or Products (rather than Services) in return for monetary or valuable considerations Eg – buying products in a retail store or online Used in a broader context of ‘Good Customer Service” Patron - A patron is a person or organization that supports another. Sometimes a customer is referred to as a Patron. Consumer – One who consumes (goods or products or services). Usually refers to a customer.

• We use ‘Patient’ in the context of Medical care – treatments, consents etc

• We use ‘Client’ for all other purposes eg financials, scheduling etc

• We use ‘Customer’ in the context of providing ‘Good Customer Service’.

We use these terms interchangeably to -

• Make them look & feel better and Make them happy • To give them their money’s worth

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THE MUST HAVE’S for Sales 1. Enthusiasm 2. Product Knowledge 3. Sales Skills 1. Trust = Get them to know you >>like you >> Trust you. Build

Empathy and Trust. They will always ask ‘Do you really care about my needs?”

2. Problem solver = it is always about them. Ask them and solve their problem. You are a PPS – professional problem solver. You are

3. Educate and Advice = we are here to ‘assist’ in their buying decision 4. Follow up – Follow up – Follow up = Takes an average of 8 to

15 attempts before you will make a sale! Never never never never give up! 5. Failure and Handling Rejections (no sales)

You will not make the sale every time you will make mistakes. It is part of the game. What is more important is how well you get up after you fall, how well you learn from your mistakes AND not make the same mistakes again. If you don’t close a sale, it’s not end of the world. Keep trying. We will judge you by your ability to get back up and go in there for another fight.

• Stick to the Price List and Discounting guidelines – Do not

deviate • Do not give unauthorized Discounts without prior permission

from regional manager or Dr Kanase • Do not give unauthorized Procedures without prior permission

from regional manager or Dr Kanase

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See Report 3a. For latest Updates and Details We do not expect 100% close rate CM – goal – consult closing ratio above 70% (Benchmark is 50%) Techs - Upsells should account for 25% of monthly revenue Category Goal Solution (if low) Leads 15 Need more marketing &

Referrals. Improve lead generation (need more events, leads)

Booked Consults per day

10 Need more marketing & Referrals. Improve lead generation (need more events, leads)

Consult No show & cancellation rate

<20% (Benchmark 40%)

Improve qualifying skills Improve phone skills on confirming consult appointment.

Attended Consult 8 Same as above Close ratio >70%

(Benchmark 50%) improve closing skills

Closed Consults 6 improve closing skills Ave sale $1500 improve closing skills Total Consult Sales $9600 improve ALL the above Upsells Revenue >30% of total

sales improve Tech sales skills

Total Upsell Sales $4114 (3-6K) Improve ALL 7 steps of sales Daily Sales Goal (C+U)

$13714 (10-15K) look at all the above

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MARKETING INVOLVES EVERYTHING YOU DO TO GET PROSPECTS TO A CONSULT. See marketing Dept. notes – Marketing Training Manual Definition - Anything done prior to their name showing in the Consult column on the scheduler. Goal – Get them to come in to see you for a free consult! This refers to generating new leads, generating new referrals from current clients etc. Our Strategy -

1. Word of Mouth – Friends and Family. REFERRAL program 2. Internet – Google, Fb, Groupon, Signature specialist.com 3. Outbound – Lead Boxes, B2B (business to business) 4. Misc – Radio, TV etc

• Friends And Family

Program Designed To Capture As Many Referrals from Current Clients The Closing Ratio on Referrals Is Higher Than Cold Leads Referral Gets 20% Discount on Package(S)—Actively Promote To Every Patient Patient Gets $250(1) $500(3) $2000(8) Towards A New Package upto 50% discount off the new package

• Lead Boxes Left at Local Business Generates Leads for Clinic, Enter to Win

Marketing – Focus on your f/u sequence customers – see dashboard>contact logs

Outbound events Marketing calendar – updated and current Complete event request forms Complete event closeout forms

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FedEx leads to corporate call center ensure upcoming events are covered by staff/event spokes models Lead boxes - make a trip to all lead boxes and enter leads. (CREATE ONLINE FORM)

Coming Soon Dream 100 clients Upscale - Target the best neighborhoods. Do more to attract them than everyday buyer Give something away. Make attractive offers Co-marketing / Strategic Partnerships / Trades Complimentary marketing – increase clientele by 45-90%

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GROUPON –

Groupon Memo for the Clinics What is Groupon? Groupon provides a’ One Day Deal’ to it’s members. The deal typically offers the buyer 50% to 95% off. However, the merchant (that's us) is charged 50% fee plus 2.5% credit card processing fee. GOALS

• Brings in Large number of NEW leads • We loose money upfront but make up by Upselling on the

back end • We get testimonials and referrals

So by way of example, if we offer Velashape 3 treatments for $99 as our ‘One Day Deal’. We only make about $48. Our cost of performing these 3 treatments is about $270. So we actually loose money, about $220 per sale on the one day deal. If we sold 100 of these then we will actually lose $22,000! That’s a large amount. Here is the good news. If we do a good job with treatments and customer service, we make money on the back end in Upsells. We hope that the new clients will want to purchase the remaining treatments of the regular 6 treatment series. We hope to convert these discount shoppers into long term clients. If 100 people buy thru Groupon and 20% are upsold and our average sale is $1500 then we make 20 x $1500 = $30,000 at the backend. We assume that these upsells will take place over a period of 4 weeks. So all told, our net income is $8000 (30000-22000). That’s big! In essence, we make $8K profit over 2 months with just 1 marketing idea. Not to mention getting testimonials and referrals. So the take home message is, we loose money upfront but make it up in Upsells and referrals and testimonials. You will be notified as we run these deals in your respective cities. It will help generate more clients.

Upselling Ideas to help improve Groupon Sales ONE Let them do 1 treatment of the area that they purchased on groupon,

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and if for some reason they decide to change to another aera, they need to let us know by the second treatment. Use this as an opportunity to upsell them the other package. An example Patient comes in for Bikini line Explain them exactly what it covers and show benefits of getting BBE instead including 50% off at $1650. They can still use the groupon for another area instead eg under arms. “Do Bikini Line today. Go home & think about BBE and if you let me know by your 2nd tx I will change your groupon to 6 LHR-underarm treatments and you can purchase the BBE at $1650 that day". This has worked very well in El Paso. TWO 50% off any of our other packages within 30 days

How to process Groupon Patients thru MB How to Schedule Appointment - Schedule Groupon appointment as “Misc – Meeting with Clinic Staff”. NOT a consultation. IMPORTANT - Make sure you have the Correct Ref code How to Process Groupon Sale - 1. See video on Intranet - How to Process Groupon Purchases 2. If they have purchased on Groupon.com – process at Zero dollars using Promo code: Groupon 3. If they are buying from you directly, either on the phone or in the clinic – process at $99 (or $49 or whatever the groupon promo amount is) What to do when they come in for their appointment – · Do a Consult with Powerpoint then if time permits give 1st treatment the same day · Have them Create Login in MB

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Procedure for Groupon Receipts Verification – MAKE IT PAPERLESS!!

If they show it on their phone/ipad etc – • Take a Photo of their iphone showing the receipt with our clinic

ipad • Upload Photo to Pts MB docs • Contact log – mention the GrouponCode so accounting can audit

it If they come in with printed Groupon paper -

• Take Photo of the Printout with clinic ipad • Upload Photo to Pts MB docs • Contact log – mention the GrouponCode so accounting can audit

it • Hand them the paper back. • NO NEED to keep papers moving forward.

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7 STEPS OF SALES (Consults & Upsells)

1. Prospecting – see Marketing. New client 2. Pre-qualifying AND Qualifying = Phone skills, Wish List,

quote sheet 3. Sales Presentation 4. Overcoming Objections 5. Closing and Paperwork 6. Customer service/follow up 7. Ask for Referrals and Testimonials

1. Prospecting – see Marketing

2. Pre-qualifying and qualifying Talking over the phone or in person, get answers to these questions

What is his/her problem that I can solve? Do they have the financial ability to pay for it? What is in their budget?

Hello Ms. Jones? How are you today? I am xyz from alc calling to confirm your complimentary consultation. Are you excited? You won a $300 gift certificate? I know you will love the services and enjoy the benefits for a long long time. Before we proceed may I ask a few questions to help make the most of your time? What is your concern that I can help you with? (What is your problem that I can solve). Waxing and shaving causes rash, too much time etc. Are you aware of the price range? Depends on the body area. Our prices start as low $25 and can be high as $18000. You can also purchase a series or package. Please visit our website for all the details and information or you can come in and we will give you all the information. Who makes the financial decisions in your family? What methods have you tried for hair removal?” How did you hear about us? What do you know about alc/procedure?

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3. Sales presentation Golden Rules • It is always about them. NEVER about us • Our job is to solve their problems • Remember the 3 Things (Get them to like you, PPS, educate and advice) and the 3

rules (enthusiasm, product knowledge, sales skills) • ALWAYS TELL THE TRUTH. If you don’t have a solution for them say you don’t

have it but will do your best to find one. Educate and Advice. Call Dr K about anything you don’t know (even while you are in the consult. Chances are he will have the answer and you will learn something new to use for future consult)

• UNDER PROMISE and OVER DELIVER • Find out about them before they walk in the door – Review Profile, contact log • Be pleasant. Be Enthusiastic. • Greet client with positive, upbeat energy. First impressions are crucial. • Start consultation with a genuine compliment. Show empathy. If you do this

effectively, client will FEEL like she is with a friend and a trusted advisor and not being ‘sold’ to

• Always make good eye contact • The GOLDEN SILENCE CONSULT Example - Hi Ms Jones. How are you! Thank you for coming in. Please fill out these papers (consult papers) and we will be right with you. (After consult papers are filled take her to consult room). I see you heard about us at the bridal show. Congratulations on winning the $300 coupon. We decided to give the $300 to people who are going to buy from us instead of spending on radio and TV ads. I see that you are interested in LHR. Currently you shave 2x a week. That’s painful and time consuming isn’t it? (GET THEM TO FEEL THE PAIN OF THEIR CURRENT SITUATION) If it’s okay with you, I would like to show you what Laser Hair removal is and what the benefits are for you. I would like to show you some pictures. Then we will go over pricing and you can make your decision. Please feel free to stop me and ask questions as you like. Explain How LHR works (Powerpoint) Laser gets attracted to color of hair – selective photothermolysis

Only 10-20% hair are in the mature stage at any given time therefore you need multiple sessions You can expect to have - may be a stray hair here or there at the end of the series Virtually zero downtime following each treatment We provide 2 yr appearance plan Discuss how treatment will work for patient

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Walk them through the procedure, what to expect with LHR Arrive with clean, shaven skin, no lotion, deodorant, etc No sun exposure, self-tanning products, waxing,depilatories, tweezing, or antibiotics two weeks prior to treatment or one week following treatment No down time following treatment Eliminates unwanted hair by destroying the root Can continue shaving between treatments Following each treatment, expect a 10-20% reduction in hair growth. Hair re-grows much thinner, less dense, and less coarse. Expect to see noticeable results after about 3 treatments Time between treatments is 6, 8, 10 weeks for head, torso and lower body respectively

Benefit for the client

Why Laser Hair Removal - • This is a procedure you will enjoy for a lifetime • No more shaving, waxing. • Evaluate cost and time saved – show a chart to illustrate that

Why American Laser Centers -

• Safe, effective, affordable • 2 yr appearance plan. No one else offers that • You can take your package with you • If you get pregnant – we freeze your package so you don’t loose the

benefit • Our lasers hurt less than some other out there. ‘Snap of rubber band’. 1-2

on a scale of 10. • Can treat all skin types and hair colors. If a clinic cannot treat African

American skin or light colored hair then they have antiquated technology • Newest and most advanced technology • We study the latest research and technology and bring you the best

technology. We try to stay ahead of the curve. Continuously check in and make sure client is on the same track as you - clarify any questions UPSELLS Upselling is a requirement of the job, not an option. On Tue conf calls we have an upselling role play sessions. This will help sharpen your skills. Make sure you know who you are treating and your potential Upsells for the whole month in advance. Use the Dashboard and Sales follow-up sequence protocol to stay on track Start with the golden rules (see above) Study their Problem list and Wish List. Make sure they are Happy with current treatment.

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Then prepare a ‘quote’ for them and have it in ‘contact log’ AND as ‘Sales ticket’ in Mindbody Present her with the great offer you have customized just for her! Follow Sales steps 3, 4 and 5 (sales presentation, overcoming objections, closing) Example of Upsell- Ms Jones, since you mentioned that shaving your legs bothers you (problem) and it is on your wish list to take care if it. Also since you have been our patient and happy with (current service) LHR – under arms, let me show you some quotes to help you make a decision to purchase today. Prepare your upsell plan before they come in for their treatment, ideally 2-3 days in advance. When she comes in for treatment – start with this ‘pre-qualified’ background. As you add more notes on your treatment record and in the contact log in Mindbody, you will have a better understanding of the patient’s needs and be able to overcome objections and close better and your upsell closes will go up!

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OVERCOMING OBJECTIONS Money and time are never the issue. They are merely a measurement of value. An objection is not a No! It means they need more information. 1. Too expensive

Our prices are very competitive. Think about the cost of what you are currently doing to take care of the issue and realize that we are here to help you eliminate the pain of shaving, waxing, and tweezing. Consider all the time and money you are spending to treat this problem now. Having to shave and the cost of razors are enough to justify the investment of laser hair removal. You will love not having to shave and the procedure will pay for itself in 1.5 years. Think of all of the time and money you will save! Velaàmuch smaller investment than liposuction and is non-invasive. STàdon’t have the down time or cost of facelift

2. I have to think about this You have taken time out of your busy schedule today to take the initiative. This is the first step to doing something you have wanted to do for some time. It will make you feel better about yourself. This is an investment in yourself and you are worth it! Don’t waste any more time thinking about it, make the commitment and let’s get you looking (beautiful/smooth/younger/….word according to the type of service).

3. I don’t know Obviously I have not answered all of your questions. Please tell me what I can clarify for you.

4. I need to discuss with my spouse. Please feel free to use our phone.

5. I checked out other places and their prices are cheaper. We offer a price match guarantee. Their prices may be lower than ours, but American laser center has the most up to date technology and you will get superior results.

6. What if I get pregnant?

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We will freeze the package thru 6 weeks from your date of delivery. You can resume treatments thereafter.

7. I don’t have any cash, checks, or credit cards with me today. Can I come in tomorrow and pay? We have 0% financing, it’s quick and easy and we will have an

approval within minutes.

8. I only want my gift certificate. I understand that you are excited. The gift certificates are good toward the purchase of a series of treatments. What procedures are you interested in today.

9. Don’t have money to put down, failed financing. I understand that money is always a consideration. Do you have someone who would co-sign for you? Or we can charge the down payment to a credit card and set up monthly payments for you.

10. I want to wait until I can save the money. Do you really want to wait to get started—we can set up monthly payments that are interest free

11. I want to see faster results I can understand wanting to see faster results. Unfortunately, due to the hair growth cycle, it takes time. Just like most things in life, this is a process and good things come in due course.

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FINANCING PROGRAM I would like to explain the benefits of our in-house financing program We offer In-house financing They are decided as follows -

1. By Procedure 2. Then by Amount

In-House Financing 0% Interest but there is a small processing fee per month – varies by amount financed ($3-$9 per mo)

Does not affect your credit score 0% interest but Small processing fee ($3 per month for $1000 loan; $9/mo for $3000 loan)

Paid in equal monthly payments by end of series. Total # of payments (months) cannot exceed date of series’ expiration

LHR – pay upto 24 months Can piggy back non-LHR with a purchase of LHR and get 2 yr

financing. Eg can get Vela for $85/mo = Mesopen $1500 sale + LHR-U lip $400 =

$1900 = $85/mo x 24 months) • Autopay payments are setup to deduct from your Credit card or

Bank a/c on file No prepay penalty

QUOTING A PRICE DO NOT quote prices until you have answered all their questions and overcome all their objections.

AFTER YOU QUOTE THE PRICE – SHUT UP!! (GOLDEN SILENCE!) Online Quote Sheet / Wish List List price = Discount #1 = eg $300 / eg month’s special 35% Final Price = You save = Financing options (Final price – down pmt (if any) = financed amount Put final price in Monthly pmt = Eg Your investment will be ONLY $87/mo

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CLOSING SKILLS Look for buying signals. Assume the sale-ask for the business- keep it simple You deserve to ask for the sale If you have followed all of the steps for consultation- the close should be easy.

• Praise their investment • Schedule first treatment immediately • Follow up next day with a phone call/ thank you for their

business • MB, PT-pad and EMR must be accurate

Celebrate the close you made! If you did not close – don’t lose heart. Put client in contact log and f/u, f/u f/u. (see below -handling rejections and failure). Also learn why you did not close (objection. Money ofcourse being the #1 objection and plan on how to overcome that objection next time) Checklist AFTER you make a sale (see ‘Checklist’ named = Sold-Consult Checklist)

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Case Study 11K Full Body Sale GAYLYNN Lubbock Dialing for Dollars I had a slow day so I went to the old ERM books of old employees I started doing follow up calls offering laser services. Telling them about the mesopen and coolsculpting was new service we are providing. I made the conversation seem like I was checking up on them and being informative about what we had to offer rather than sounding like I was pitching a sale. I received a lot of no answers from lots of people I called. I started calling when we opened and didn’t get my first yes until after lunch! Sterlyng also started calling clients to offer first time treatments of the Mesopen and answering other questions they had. Calling No Show Consult from the past I offered free consultations. The client I called had not showed up to her first consult but I called anyway. Consultation She came in. I explained how laser hair removal worked and how the GentleYag laser would be the best for her skin. I took her in the room and showed her the laser. We went back and I offered her a groupon for small area. Then asked her if she would like to try other areas. She said, yes everything! I said okay I”ll give you the full body half price and you can finance that for 24 months. Quoted her the prices. Handed her the quote sheet to look over. Asked her if that would work for her, then I shut up. She answered yes. We then pulled up the consent form that I went over in detail with her then she signed we moved on to the skin test then booked appointment. The next lady I did a follow up I told her of the same things. She in return told me her daughter had been burned. We talked longer about her daughter I assured her she would be given the best service to correct the issue. At the end of the

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call she decided to get a full arm treatment and paid (? for her daughter). She will be in shortly for treatment.

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REFERRALS Word of mouth Friends and Family program—(marketing training)

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TESTIMONIALS Google Review FB Reviews Yelp Reviews Listen 360

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CUSTOMER SERVICE MANAGING EXPECTATIONS – Step 1 = Set Goals = eg 6 Tx 90% hair gone

Establish Ground Rules = eg no tanning , Tell us about Pain, no show fee, shave, etc Clarify Expectations = check again that you can deliver what they want

Step 2 = Monitor Progress and Change as needed. % Graph. Increase settings

Step 3 = Manage Expectations throughout the whole process PROPER CLIENT / PATIENT SELECTION – Medically = see what problem they have and can you fix it Eg someone with white hair is NOT a good candidate Someone with Morbid obesity or excessive loose skin on abdomen is NOT a good candidate Socially = see if they are a good fit If they seem too ‘out there’ or their expectations are way off Eg lot of fat that truly requires lipo but they demand vela and expect lipo results A persistent Tanner who still states we must treat her every time regardless and who you feel will blame you for everything if she gets burned

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Good Customer Service Front Desk – Dress Code = Professionally dressed per policy Facial Expression =

• Smile. Recognize them by their name. • Be Present for them. If a phone rings, let it go to VM but do not

ignore the client in front of you! • DO NOT be Rude

Language =

• DO NOT use street language. Eg ‘Yag doesn’t hurt white people’ • Use professional language • You are being watched by them the whole time. Act accordingly.

Team Work =

• DO NOT rely on others to do the work • Jump in & take initiative so that workflow is smooth • Customers SHOULD NOT have to wait.

Follow the Rules of Conduct Definition – They get results of the service they paid for AND they FEEL you cared for them Goal – Make them HAPPY! Be ‘TRU’ to the Customer (TESTIMONIALS, REFERRALS, UPSELLS) Timeframe - From the time they come in for their 1st treatment until they complete their package This is what makes loyal repeat clients Get them to Know, Like and Trust you First treatment on the same day if possible Schedule recurrent appointments thru expiration Coming soon Mindbody/Infusionsoft = Sending thank you emails to new clients Follow up sequence

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Greet them with a smile and their NAME Good eye contact Anytime Dr K has to see a problem patient, the CM and the tech involved MUST be in the room with the patient. FAQ I am not seeing results My contract expired and I am not seeing results Transfers – I was promised I could transfer. Now I can’t Appointment change Too much time on phone to book my appointment Why can I not buy single treatment? Do’s & Don’ts – Know who is coming to the clinic beforehand Greet them with a warm smile and good eye contact immediately DO NOT – discuss details in the waiting room. Take them to a private area – eg consult room DO NOT – make them feel ignored If treatments are running late, keep them updated/informed In the treatment room – Ask them if they need drape so they feel privacy eg underarm LHR Act professionally at the front desk – NO PERSONAL TALK about your personal lives DO NOT discuss other patient’s at the front desk. DO NOT use street language at front desk – be a professional L360 – covered in IT Training Tom Hopkins Audio

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ADDENDUMS

• Consult Papers – on Website • Consents – on Website • Checklists – (Pre-Intra-Post) Procedure • Checklists – Morning, Intraday, Nightly, Weekly,

Monthly • Inventory Sheet – see document library