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CRYOSKIN CONSULTATION
Description
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Email
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Your email
First and Last Name
Your answer
Phone Number
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Your answer
Date of Birth
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Treatment History
Have you ever tried any other aesthetic procedures in the past?
Yes
No
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If "yes", which ones?
Your answer
How did you hear about Cryoskin?
Friend/Family
TV/Radio
Internet
Other
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Background Information (check all that apply)
Botox in the past 30 days
Surgery in the past 6 months
Pregnant and/or breastfeeding
Lymphatic disorders
Severe allergy to cold
Fillers in the past 90 days
Breast implants
Active/Past Cancers
Uncontrolled Diabetes
Severe Raynaud's Syndrome
Eczema, rashes, or dermatitis
Open or infected wounds
Circulation
Pacemaker/metal implants
Mesh Inserts
Incision scar(s) in desired area
HIV/AIDS
Body piercings in the desired area
Using topical antibiotics
Progressive diseases (MS, ALS, etc.)
Lifestyle information
How many times per week to you exercise?
Your answer
How much water do you drink per day?
Your answer
How would you rate your diet?
Extremely healthy
Generally healthy
Needs improvement
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How many sessions do you want?
1 Session Facials are $250 Body is $350
3 Sessions of body 975 saving $75
5 Sessions Facial $995 Saving $225
5 Sessions Body $1500 Saving $250
10 Sessions Body $2750 Saving $750
10 Sessions Facial $1500 Saving $1000
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Do you have questions about Cryoskin
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