BODY SCULPTING INTAKE FORM

Before your scheduled appointment please drink 4-6 bottles of water. The more water you drink the better your results will be.

First name

Last name

Phone

Message

Do you have any chronic medical conditions that we should know about?

Are you currently taking any medications?

Do you have type 1 or type 2 diabetes?

Do you have high blood pressure?

Have you had cancer in the past 12 months?

Do you currently have cancer? If yes, are you currently on chemotherapy?

Do you have any medical devices implanted including, but not limited to, hearing aids, a pacemaker, or hormonal pellets? If yes, please list...

Do you have any known kidney or liver disorders?

Are you currently pregnant or nursing?

When was the first day of your last menstrual cycle?

Body Sculpting Terms & Conditions

Day of appointment:

Prior to starting your first session and during each 3-day period of treatment, we recommend you to drink 2-3 liters of water. Water and hydration are key to this process being effective.

To maximize the effectiveness of your sessions, it is best to restrict products that impact lymphatic flow during the program. (caffeine, alcohol, and sugar in large amounts)

we recommend eating a healthy diet to stabilize the fat and inches loss you obtain during the program.

Always consult with your physician before beginning any Health & Diet program

Always inform us if you have change in health status or experience any unusual symptoms during the program.

We recommend additional daily exercise to stimulate lymphatic flow. This includes low impact workouts: brisk walks, swimming, or cycling during this process. Adding this activity to your ongoing lifestyle will help to stabilize your weight and fat loss.