Got Cellulite? Candidate Application Form

Got Cellulite? Candidate Application Form

We're thrilled that you're interested in transforming your body with STAR-T Cryo Body Sculpting! This exciting opportunity allows five selected candidates to experience our cellulite reduction services at a highly discounted rate while participating in our progress-monitoring campaign. Please complete this short application so we can determine if you're the ideal fit for this program.
Personal Details
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Height*
Weight*
Body Mass Index (BMI)
Unsure of your BMI? We'll calculate this for you during the evaluation.
Health History
Do you have any pre-existing medical conditions we should know about?*

NoYes
If yes, please specify:
Have you had any surgeries or medical procedures in the past 6 months?*

NoYes
If yes, please provide details:
Are you currently pregnant, breastfeeding, or planning to become pregnant?*

NoYes
Do you have any allergies to cooling gels, topical products, or adhesives?*

NoYes
If yes, please specify:
Lifestyle & Exercise
How would you describe your daily activity level?*

Sedentary (little to no exercise)Lightly active (e.g., walking or light exercise 1–3 times per week)Moderately active (e.g., moderate exercise 3–5 times per week)Very active (e.g., intense exercise 6–7 times per week or a highly physical job)
What is your current exercise routine?*

No routineLight exercise (e.g., walking, yoga, stretching)Moderate exercise (e.g., cardio, weightlifting 2–3 times per week)Intense exercise (e.g., CrossFit, endurance training)Other
Do you follow a specific dietary regimen?*

No specific regimenClean eating (minimal processed foods)Keto or low-carbIntermittent fastingVegan or plant-basedOther
Treatment Goals & Commitment
What areas of your body would you like to target? (Check all that apply):*

ThighsButtocksStomachArmsOther
What are your primary goals for this treatment? (Check all that apply):*

Reduce celluliteTighten loose skinTone specific areasImprove overall contourOther
How committed are you to achieving your desired results?*

I’m 100% in and willing to follow all recommendations.I’m motivated but may need occasional reminders to stay on track.I’m unsure and may need additional support or guidance.
Are you wiling to commit to:
Following a clean diet?*

YesNo
Completing recommended lymphatic drainage exercises?*

YesNo
Attending all scheduled sessions?*

YesNo
Sharing your progress through photos and feedback (your identity can be anonymized)?*

YesNo
Why do you think you would be the perfect candidate for this program? (Short answer)*
Should be Empty: