Body Contouring Client Consultation Form
PLee Beauty, LLC | 3409 Schofield Ave. Suite A Weston, WI 54476 | 715-254-8989
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First & Last Name *
Phone Number *
Email *
Date of Birth *
MM
/
DD
/
YYYY
Treatment area interested in (Check all that apply) *
Required
Medical Background: Are you, or do you have? (Check all that apply) *
Required
Current medications (include vitamins, supplements, etc) *
Food/medical allergies *
Other medical conditions not listed above *
“Before” and “After” photos/videos are required by PLee Beauty’s insurance. We would like your permission to use these photos/videos for advertising. For example: in portfolios, online, and in print ads, etc. Your consent is necessary regarding this. Please note, your face will never be shown. See below for an example. *
Captionless Image
Required
A non-refundable deposit of ($50 for single session; $99 for package sessions) is required to secure an appointment. Package sessions need to be paid in full at the time of the first appointment in order to receive the package discount. All prepaid services are non-refundable. Once a date is set and the deposit is made, you will receive an appointment notification. Submission of this form does not guarantee you an appointment. PLee Beauty will reach out to you to discuss further details. *
Required
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