SBS CULT Consultation Form

Name

First NameLast Name

Email

example@example.com

Address (If mobile services are applicable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Where are you traveling from? Will you be staying locally during your recovery?

Approximate length of stay:

1- PROCEDURE INFORMATION: What procedures are you having or have had?

Location of Surgery

Have you already had your surgery?

If yes, date of surgery:

How many days / weeks post-op are you currently?

2- RECOVERY NEEDS: What are you primarily seeking support with?

Have you experienced fibrosis, hardened tissue, lumps, or areas of uneven texture following surgery?

Please describe your current surgery concerns:

3- TRAVELING & SCHEDULING: When will you arrive in the area?

When will you depart?

Preferred appointment frequency:

Preferred appointment times:

Will your recovery schedule need to accommodate other appointments, travel, or post-op visits?

If yes, please explain:

4- YOUR PREFERRED EXPERIENCE: Which best describes what you're looking for?

What is most important to you during your recovery?

5- PACKAGE INTEREST: How many post-op sessions were you considering?

What level of recovery support are you looking for?

6- MEDICAL & RECOVERY CLEARANCE: Has your surgeon cleared you for post-operative lymphatic/recovery care?

Are there any current restrictions from your surgeon?

Please disclose any conditions, complications, medications, or other factors that may affect your ability to safely receive post-operative bodywork.

Are you currently experiencing any symptoms that your surgeon has instructed you to seek medical attention for?

If yes, please explain:

Important: SBS Cult does not diagnose, treat, or replace medical care. Any concerning symptoms or post-operative complications should be addressed with your surgeon or medical provider.

7- PHOTOS: If appropriate for your consultation, you may be asked to provide current recovery photographs.

Photos provided for consultation will not be used for marketing without separate consent.

8- YOUR RECOVERY GOALS: What would make your recovery experience feel successful to you?

Is there anything else you'd like us to know about your recovery, travel plans, or expectations?

CONSULTATION ACKNOWLEDGMENT

By submitting this form, I understand that the consultation is used to determine whether SBS Cult's services are appropriate for my requested recovery support and to recommend an appropriate service or package.

I understand that SBS Cult does not replace medical care and that I remain responsible for following the instructions and restrictions provided by my surgeon and medical team.

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