Body Assessment Questionnaire

Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Body Assessment Questionnaire
1. What areas of your body are you hoping to improve or sculpt?*

StomachBackThighsArmsOther
2. Have you noticed any cellulite, dimples, or indentations in the treatment area?*
(If yes, describe what you see.)
Please Describe*
3. How would you describe your skin’s firmness in the target area?*

LooseFirmModerateUnsure
4. Do you experience any swelling or fluid retention?*

DailyOccasionallyOnly after certain activities.
5. When standing relaxed, do you see rolls, folds, or bulges you’d like to reduce?*
6. Describe your skin texture in the treatment area.*

SmoothRoughUnevenMixed
7. Have you had body-contouring services before?*
(If yes, what treatments and when?)
Please Describe*
8. How sensitive is your skin to touch or pressure?*

Not sensitiveMildly sensitiveVery sensitive
9. What is your current hydration level?*
(Be honest — water warriors and soda soldiers both welcome.)
10. What is your main goal for this service?*

Snatched waistSmoother skinReduced rollsBetter definitionOther
Should be Empty: