Body Contouring Quote Name * First Name Last Name Phone * (###) ### #### Email * Do you have any medical problems? * If yes, please list. What is your goal with body contouring? * What are your primary area(s) of concerns? * Do you want to loose body fat? * If yes, where Do you struggle with bloating? * if yes, does your stomach feel hard or soft when you push down on it? Do you want to tighten the skin on your body? * If yes, where Do you exercise regularly? * If yes, how often Do you sweat at all? * if yes, how easy and how often Do you currently follow a diet? * Average alcohol intake? * Average water intake? * Average caffeine intake? * What service(s) are you interested in mostly * If you already know which package you would like to purchase, which one ? EX: Belly Blast, 360 Blast, Tighten & Tone. What is your budget? * Packages are more than $300. Payment plans are accepted so payments can be reasonable for clients. Which payment option works best for you if needed? * Elysian Flex Pay - Bigger Down Payment & Pay by session. Elysian Split Pay- Choose Your Down Payment & Finance remaining amount AfterPay- 4 Interest free payments every 2 weeks. PayPal Buy Now Pay Later- 4 Interest free payments every two weeks Cherry Financing- 3,6,12 monthly payments. Pay in Full How much would you like your payments to be around? * Preferred start date * What days/hours would you be available for sessions? * Do you have any additional information to add? * Thank you!