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Full Name *

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What’s your biggest concern at the moment? *

Cellulite

Bloating or Inflammation

Stubborn Body Fat

Lack of Tone

Post-Surgical Swelling or Fluid Retention

What body area would you love to improve or feel better about right now? *

Abdomen

Booty

Arms or Bra Fat Area

Back

Legs

Yes, All of the Above

Which of the following have you tried before? *

Diets or Cleanses

Gym or Exercise Programs

Lymphatic Massage or Drainage

CoolSculpting or other body enhancement treatments

Detox Products

Nothing Yet-I'm just getting started

Have you had any surgeries in the last year? *

No

Yes (please explain with date)

Have you had any of the following? *

Pregnant, Nursing or Trying to become Pregnant

Active Cancer, Cancer Treatment or Cancer within the Last Year

Lymphedema

Blood Clotting Disorders

Implanted Medical Device

Other Medical Conditions not Mentioned

Surgery within Last 3 Months

None of the above

How ready do you feel to start a body transformation journey if we're a good fit? *

I'm Ready Now and Excited to Get Started

I Need to Learn More Before Deciding

Just Curious- no immediate plans

If we find you're a good candidate, are you open to discussing a personalized treatment plan? ($3K+ range) *

Yes, I'm ready to invest in myself

Possibly, but I need something more budget friendly

Not now, I'm just exploring