"Email Consultation Request"
"It's as easy as 1,2,3! 1. Enter your information, 2. Take pictures on your phone and 3. Upload. On of our team members will review and email you with a quote. In the event your situation is more complex, we may recommend a Formal Consultation.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Age
*
Height
*
Weight
*
List all medical conditions
*
List all medications you currently take and what they are for
*
Drug allergies
*
List any surgeries or procedures in the past 5 years. When were they?
*
Which sections of the body are you interested in treating?
*
Lower Body: Thighs
Midsection: Abdomen and Waist
Upper Body: Arms, Upper back, Chin
Are you interested in Fat Transfer?
*
Butt or BBL
Breasts
No Thanks
Describe your situation, any concerns and specifically what you would like to treat.
Take pictures with your phone. You may use a mirror. Undergarments preferably. Please show your skin in the areas that you wish to treat. We require 4 FULL LENGTH photos from head to toe: Front, Sides and Back. Watch instruction video - https://youtu.be/ZMhoqj8yPwM
* If the pictures are not sufficient, we may request additional photos which will delay your consultation."
Upload your Front View
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload your Back View
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload your Left View
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload your Right View
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Message / Additional Info
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