BodyByTira Consultation Form

BodyByTira Consultation Form
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
IMPORTANT! PLEASE READ BEFORE BOOKING (Terms & Conditions)
Please be on time. Clients are booked back to back. You are given a 15 minute grace period however it will cut time off of your treatment. After 15 minutes, there is a $25 late fee.

Please do not bring extra people.

If you need to reschedule, please do so no less than 24 hours prior to your appointment. Rescheduling less than 24 hours will forfeit your deposit because it held space for a client who could've booked for that time and actually showed up.

No call, no shows will be banned from scheduling future appointments. If you can’t make it, please be considerate and let me know!
I have read the above request and agree to the terms?

YesNo
NEW CLIENT ELGIBILITY
Are you 18 years old or older?

YesNo
Are you pregnant or breastfeeding?

YesNo
Have you had any recent surgeries in the last 6 months?

YesNo
Do you have a pacemaker, or any metal in your body due to any previous surgery? *

YesNo
Do you smoke?

YesNo
Are you currently taking medications

YesNo
If so, Please Explain
Will you be on your menstrual cycle during the time of your appointment?

YesNo
Do you have any of the following:

Skin DiseaseBlood DisordersHerpes or HIVHepatitis B or CHypersensitivityNONE OF THE ABOVE
After filling out the form, if you haven't booked an appointment please go to the website www.rejuvenatesteamspa.com, under Body Sculpting and book your appointment.

PLEASE MAKE SURE YOU ARE DRINKING AT LEAST A GALLON OF WATER 3 DAYS PRIOR TO YOUR APPOINTMENT.

BRING SOME FORM OF COMPRESSION. (ex. shapers, waist trainer, girdles, etc)

TRY TO WEAR ALL BLACK UNDER GARMENTS
Should be Empty: