• Medical History

    Medical History

    Please complete before our consultation. If there are questions that you would prefer not to answer or you do not know the answer then just leave them blank.

  • If you checked any of the above, you do not qualify for the non invasive fat reduction procedure at this time. Please do not go any further and please do not submit this form. 

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  • Contact Information

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  • Health Assessment and Medical Information

  • Dietary and Lifestyle Habits

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  • Prior to your procedure:

    Do not eat within 2 hours.

    Take a shower or bath to rid the body of excess oils and lotions. 

    Do not wear any oils, lotions or perfume. 

    Do not wear stomach piercing.

    Do not wear jewelry. 

    Do not get a tan in sun or tanning bed. 

    Do not get the procedure if you're on your menstruation. 

    After your procedure:

    Drink a bottle of water immediately following.

    Drink a gallon of water every day. 

    Do not get in a sauna until 3 days after procedure.

    Do not take a shower or bath until the next day. 

    Exercise for 30 minutes a day.

    Use waist trainer and slimming scrub. 

    Follow the meal plan. 

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  • I have answered every question truthfully. I am aware that this is non-invasive fat reduction and results may vary.

    I am signing this form giving the practioner consent to perform a non-invasive fat reduction procedure. 

  • Thanks for taking the time to complete this intake form.
  • Clear

  • To be filled out by the practioner.

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