Body and/or Facial Contouring - Consultation Form

Name

First Name Last Name

Phone Number

Email

example@example.com

What is your area of concern?

How long has this area been a concern for you?

What bothers you? (Skin tightening, Cellulite, Fat)

Are you preparing for a special event? Do you have a goal date?

Have you had any treatments before? If yes, what kind?

Any recent weight gain or loss? If so, how much?

Any recent pregnancy? If so, how recent? Are you breastfeeding?

What are your overall goals?

Do you exercise regularly? How often? What kind of exercise?

How is your diet?

Do you have any medical conditions we may need to know about?

Do you have any known allergies?

Are there any additional concerns, or questions?

Pre & Post Treatment Information

It is important to drink a minimum of 40oz of water before your treatment. Avoid Alcohol 3-4 days prior to treatment. The liver will filter alcohol first, and fat cells later. Liquid activates the lymphatic and moisturizes the skin. Do not substitute carbonated begverages for waters! The more you are hydrated, the better results you will see. Make sure to drink large amounts of water (not cold) to flush out system. Do not each fatty foods within a 24-hour period before or after your treatment. This allows your body to focus on the fact we are trying to remove instread of new fat introduced. Each high protein, low carb and low sugar diet. While not encessary, you can maximize your results by exercising 2 hours after the treatment. Sweat and a high heart rate increase circulation, allowing your body to adjust with the newly released liquid from the fat cells. Contouring treatments are to be scheduled at least 1 week apart. There is a recommendatin of 8-10 treatments for the body, and 6 treatments for the face and neck.

Possible Side Effects

Some bruising may occur with the suction treatment and possibily with the heat of Radio Frequency treatment. It is minimal and it will resolve itself.

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