Full Name
Phone Number
Email
How did you hear about Sculpted Body Contour? – Referral Instagram TikTok Facebook Yelp Google Ad
Body Goals & Focus Areas:
What are your main areas of concern?
What are your body goals? – Tone & Tighten Reduce Bloating Contour Waistline Lift Glutes Detox Cellulite Smoothing
What event, milestones or reason inspired you to start sculpting now?
Have you received any body contouring treatments before? If yes, which ones and when?
What type of results are you hoping to achieve? – Instant Shaping Long-Term Maintenance Full Transformation
How soon are you hoping to see results? – Preparing for an Event (1-2 Months) Consistent Lifestyle Change (3-6 Months) Long-Term Transformation (6+ Months)
How would you describe your activity level? – Sedentary (little to no exercise) Lightly Active (1-2x per week) Moderately Active (3-4x per week) Very Active (5+ per week)
How much water do you drink daily? – Less than 32oz 32-64oz 64-100oz 100+ oz
How many hours of sleep do you get per night? – Less than 5 5-7 Hours 7-8 Hours 8+ Hours
How would you describe your current diet? – Balanced Low Carb High Protein Skip Meals Fast Food Often
Do you drink alcohol or caffeine regularly?
Do you smoke or vape?
Are you currently on any detox, supplement, or fitness routine? (If yes, please list)
Are you currently under high stress? (If yes, what helps you decompress or relax?)
Body History & Contraindications
Your safety is always first. Please check any that apply:
Taking any medications or birth control? (List)
Any know allergies or sensitivities (gel,essential oils, etc.)
Have you experienced bloating, water retention, or digestive issues recently?
Do you feel your body holds tension in certain areas?
Are you more prone to cellulite, puffiness, or inflammation?
Do you experience hormonal changes that affect your body (PMS, menopause, etc.?)
How many sessions per week are you open to committing to? – 1x week 1-2x week 2-3x week
Are you interested in a short series (3-6 sessions) or full transformation program (8-12)? – 3-6 Sessions 8-12 Sessions
What’s your biggest motivation for starting this journey?
On a scale of 1-10, how committed are you to your body goals right now?
Would you like us to recommend supplements, teas, or post-care tools to support your results? – Yes No
Agreement & Acknowledgment
Full Name (acts as signature):
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