"MyShape Lipo Consultation Request"

"Consultation Request"

Save time, money, and stress — with an honest plan made for you.
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What You Get With Your Consultation
✔ Honest Assessment
No sales pitch. Just a clear breakdown of your body and goals — what you actually need, and what you don’t.

✔ Clarity on Your “Why”
We’ll uncover your true desires so your decision aligns with your vision — and prevents regret.

✔ All Options Explained
Surgical and non-surgical solutions laid out in plain English — so you understand every path forward.

✔ Realistic Expectations
The risks, recovery, and possible complications — explained honestly, so there are no surprises.

✔ Protection from Sales Tactics
Avoid being upsold or taken advantage of. I’ll help you spot red flags and keep control of your choices.

✔ Best Price, Right Doctor
I’ll guide you on how to negotiate rates and choose the surgeon who fits your needs — not theirs.

✔ Save Time, Money & Stress
No more endless Googling or confusing consults. Walk away with a clear, educated plan to move forward confidently.

👉 This is your safest, smartest first step.
Book your consultation now and move forward with peace of mind, clarity, and confidence.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Age*
Height*
Weight*
List all medical conditions*
List all medications you currently take *
Drug allergies*
List any surgeries or procedures in the past 5 years. When were they?*
What’s bothering you most? Not what you think you need—what you really want. (Ex: “I hate how my pants fit,” “I just want to wear knee-high boots,” “I feel insecure about my nose.”)
What have you already tried to fix this? (Examples: diet, exercise, non-surgical treatments, surgery, covering it up, avoiding the issue.)
How does this affect you mentally or emotionally? (Examples: insecurity, low confidence, shame, anxiety, sadness, frustration, isolation, constant comparison, hopelessness)
Define Success – Clarify Your Vision. Imagine everything goes perfectly and you achieve total success. Describe it in detail—how does it look, feel, sound, even smell or taste?
Is there anything else you’d like me to know? (Special questions, personal backstory, or details you think will help me understand you better.)
Have you had other consultations about these concerns? What were the recommendations? Did you agree?
What do you hope to achieve with this consultation? How can I serve you best?
Where did you hear about me? Facebook, Google, Instagram, Friend/Family, Radio etc *
Photo Instructions: Use your phone (a mirror is fine). Wear undergarments if possible. Make sure the treatment areas are visible (show skin). Take 4 full-length photos (head to toe): front, both sides, and back. 📹 Watch the step-by-step guide here: https://youtu.be/ZMhoqj8yPwM

* If the pictures are not sufficient, we may request additional photos which will delay your consultation."
Upload your Front View*

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Upload your Back View*

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Upload your Left View*

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Upload your Right View*

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Message / Additional Info
Consultation Date & Time: Choose a date and time for your call to discuss your options. If you have any questions or concerns, text me at 702-776-9371. I’ll call you within about 30 minutes of your selected time.⚠️ Note: The $200 consultation fee is non-refundable.*

My Products

Body Shape AnalysisYour photos will be reviewed by our Trevor and you will be called at the specified time. You will receive a personalized action plan and assistance moving forward. *This fee is non-refundable.

$200.00

Total

$0.00

Credit Card

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Last Name

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Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

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"Consultation Request"

Photo Instructions: Use your phone (a mirror is fine). Wear undergarments if possible. Make sure the treatment areas are visible (show skin). Take 4 full-length photos (head to toe): front, both sides, and back. 📹 Watch the step-by-step guide here: https://youtu.be/ZMhoqj8yPwM