Name
*
First Name
Last Name
Name on Instagram or Facebook
*
Email
*
example@example.com
Phone Number
*
Do you have any of the below contraindications (this is for treatment purposes)
*
Contagious skin disorders
Advice infections (cold sores)
Skin irritation, rash, open lesions
Cancer, chemo or radiation
Diabetes
Cardiac Disease
Pacemaker or internal defibrillator
Laser or IPL within last 7 days
Roaccutane or other prescription strength
photosensitizing medications
Blood thinners/Aspirin
Metal plates or pins
High/low blood pressure
Pregnancy or breastfeeding
Vascular conditions
varicose veins
Metabolic conditions -
Hypertriglyceridemia
Hearings aids - need to be removed and off
Liver disease or high cholesterol
Autoimmune disease or pool
lymphatic system
None of the Above
Have you had body sculpting before?
YES! I love it
No, but I feel it could help me
What area or areas would you like us to work on ?
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