CHECK-IN FORM
First Name
*
Last Name
*
Phone
*
Check-In For
*
Body Contouring (General)
Body Cavitation
Laser Lipolysis
CoolSculpting
EMSculpt
Pressotherapy
Advanced Facial Treatments (General)
Microneedling
Microdermabration
Dermaplaning
Chemical Peel
LED Light Therapy
Cryo Facial
PRP / PRF Facial
HydraFacial
Deep Cleansing Facial
Hair Loss Restoration (Non-injectable)
Hair Loss Restoration (Injectable)
Topical Exosome
Botox
Xeomin
Jeuveau
Dermal Fillers
IM Shots
IV Drip
PRP / PRF Body
Hair Removal Laser
CO2 Laser
Pico Laser
Erbium Ablative Laser
Erbium Fractional Laser
IPL Photofacial
Laser Tattoo Removal
Laser Vein Removal
Consultation
Other
No elements found. Consider changing the search query.
List is empty.
Treated Area
*
Abdomen – Upper
Abdomen – Lower
Ankles
Arms – Upper
Arms – Lower
Bra Line – Front
Bra Line – Back
Back – Upper
Back – Mid
Back – Lower
Bikini Line – Standard
Bikini – Extended
Brazilian – Full
Buttocks – Upper
Buttocks – Lower
Calves
Chest
Feet / Toes
Hands
Hips
Knees
Thighs – Inner
Thighs – Outer
Thighs – Back
Thighs – Front
Underarms / Axilla
Waist / Sides (Flanks / Love Handles)
Face – Full
Face – Lower (Perioral / Jawline)
Face – Cheeks
Face – Sideburns
Upper Lip
Chin
Jawline / Beard Area
Neck – Front
Neck – Back
Nape / Hairline
Full Body
Other (Specify in Notes)
No elements found. Consider changing the search query.
List is empty.
Measurement
*
Treated Area
*
Upper Face – Horizontal Lines
Upper Face – Between Brows (Frown Lines / “11s”)
Upper Face – Eyebrow Lift
Upper Face – Crow’s Feet (Sides of Eyes)
Upper Face – Bunny Lines (Sides of Nose)
Mid / Lower Face – Nasolabial Area (Smile Fold Support)
Mid / Lower Face – Gummy Smile
Mid / Lower Face – Lip Lines (Smoker Lines)
Mid / Lower Face – Lip Flip (Upper Lip)
Mid / Lower Face – Corners of Mouth (Downturned Corners)
Mid / Lower Face – Chin (Dimples / Orange Peel)
Mid / Lower Face – Jawline Slimming / Masseter
Neck & Lower – Neck Bands (Platysmal Bands)
Neck & Lower – Necklace Lines (Horizontal Neck Lines)
Neck & Lower – Décolletage (Chest Lines)
Functional / Other – TMJ / Jaw Tension (Masseter)
Functional / Other – Migraine / Headache Treatment
Functional / Other – Excessive Sweating – Underarms
Functional / Other – Excessive Sweating – Hands
Functional / Other – Excessive Sweating – Feet
Functional / Other – Other (Specify in Notes)
No elements found. Consider changing the search query.
List is empty.
Before Picture
*
What Type of Appointment Is It?
*
Promotional Appointment
Paid Single Appointment
Use Membership Appointment
Use Package Appointment
Consultation Only
Complementary Appointment
No elements found. Consider changing the search query.
List is empty.
Any Special Requirements / Requests (Patient)?
*
Yes
No
Patient's Special Requests / Instructions
Patient Signature
*
Clear
Provider
*
Jasmin
Sophia
Eden
Alan
Gia
No elements found. Consider changing the search query.
List is empty.
Any Special Notes (Provider)?
*
Yes
No
Check-In Notes
Provider Signature
*
Clear
Check-In!