Intake Form | Tru Contours

First name

Last name

Email

Phone

What service are you receiving today?

Are you currently pregnant or think you may be pregnant?

Yes

No

Have you had surgery within the past 6 months?

Yes

No

Do you currently have any kidney, liver, or thyroid conditions?

Yes

No

How much water do you typically drink each day?

Less than 32 oz

32=64 oz

64–96 oz

More than 96 oz

Have you had a body-contouring treatment before?

Yes

No

What are your primary treatment goals?

Is there anything else you would like us to know about your treatment goals?

CONSENT

I certify that the information I provided is accurate. I understand that Tru Contours results vary by individual. I consent to the use of my information and photos, when provided, to help determine appropriate aesthetic services. I agree to the Tru Contours Terms & Privacy Policy.