• Client Medical Screen and Pre-Booking Form

    Client Medical Screen and Pre-Booking Form

  • First Day of Treatment (preferred appointment date). For appointment time choose from : 11am, 12pm, 1:30pm, or 3:00pm. Current availability is on Sundays and Mondays. SAME DAY booking is not available*
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    2 digit month, 2 digit day, 4 digit year
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Sex
  • Listed are the medical contraindications for body contouring treatments. Please select conditions that apply currently or are historically true within the last 3 years. Your body contouring specialist will review your selections to ensure treatments to you will pose no medical harm.
    Rows
  • Which body area would you like treatment? (Select all that apply)
  • Should be Empty: