Body Assessment Questionnaire
Please complete this form to help us understand your goals and create a personalized body assessment plan.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What areas of your body are you hoping to improve or sculpt?
Stomach
back
Thighs
Arms
Other
Have you noticed any cellulite, dimples, or indentations in the treatment area?
Please Select
Yes
No
How would you describe your skin’s firmness in the target area?
Loose
Firm
Moderate
Unsure
Do you experience any swelling or fluid retention?
Daily
Occasionally
Only after certain activities.
When standing relaxed, do you see rolls, folds, or bulges you’d like to reduce?
Describe your skin texture in the treatment area.
Smooth
Rough
Uneven
Mixed
Have you had body-contouring services before?
Yes
No
How sensitive is your skin to touch or pressure?
Not sensitive
Mildly sensitive
Very sensitive
What is your current hydration level?
(Be honest — water warriors and soda soldiers both welcome.)
What is your main goal for this service?
Snatched waist
Smoother skin
Reduced rolls
Better defination
Other
Submit
Should be Empty: