What areas are you interested in having treated?

Do you currently have a concern with loose skin in your abdomen?

How soon are you hoping to have your procedure?

Are you interested in hearing about our financing options?

Do you currently have any illnesses?

Are you wheelchair bound?

Are you currently taking any medications?

Do you use drugs i.e. marijuana?

Do you smoke?

Do you have a current pain contract?

Do you have medication allergies?

Are you allergic to any of the following:
(Please select all that apply)

Additional medical conditions:
Please select all that apply

Do you have a history of the following?

Are you currently or recently pregnant?

Have you had any past/recent surgeries?

Have you had any other cosmetic surgeries/ procedures (Bariatric, Abdominoplasty, Breast, etc):

Have you had any past surgical or anesthetic complications?

Have you had an organ transplant or are you currently on the organ transplant waiting list?

Have you had surgery on the area you want treated within the last 6 months?