{"id":226,"date":"2026-10-29T07:07:16","date_gmt":"2026-10-29T07:07:16","guid":{"rendered":"https:\/\/theaestheticist.ca\/?page_id=226"},"modified":"2026-10-29T07:07:17","modified_gmt":"2026-10-29T07:07:17","slug":"body-contouring-client-consultation","status":"publish","type":"page","link":"https:\/\/theaestheticist.ca\/?page_id=226","title":{"rendered":"Body Contouring Client Consultation"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Welcome to The Aestheticist Skincare Solutions. Please complete this body contouring client consultation form below. If you have questions, call 587-602-3694 or email theaestheticistcanada@gmail.com.<\/p>\n\n\n<div class='fluentform ff-default fluentform_wrapper_3 ffs_default_wrap'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_3_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Body Contouring Client Consultation<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='226' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"b4d1698c63\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F226\" \/><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_1\" ><h3 class='ff-el-section-title'>Welcome \u2014 The Aestheticist Skincare Solutions<\/h3><div class='ff-section_break_desk'><p>Welcome to The Aestheticist Skincare Solutions. Please complete this body contouring consultation form. Questions? Call 587-602-3694 or email theaestheticistcanada@gmail.com.<\/p><\/div><hr \/><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_names_first_name_' id='label_ff_3_names_first_name_'>First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_3_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your First Name\" autocomplete=\"given-name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_names_last_name_' id='label_ff_3_names_last_name_'>Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_3_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your Last Name\" autocomplete=\"family-name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_email' id='label_ff_3_email'>Email<\/label><\/div><div class='ff-el-input--content'><input autocomplete=\"email\" type=\"email\" name=\"email\" id=\"ff_3_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text' id='label_ff_3_input_text'>Phone Number<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" placeholder=\"Enter your telephone number\" data-name=\"input_text\" id=\"ff_3_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_datetime' id='label_ff_3_datetime'>Date of Birth<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date of Birth Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_3_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=false><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--label'><label aria-label=\"Address\">Address<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_address_1_address_line_1_' id='label_ff_3_address_1_address_line_1_'>Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_3_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Address Line 1\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_address_1_address_line_2_' id='label_ff_3_address_1_address_line_2_'>Address Line 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_2]\" id=\"ff_3_address_1_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Address Line 2\" data-key_name=\"address_line_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_address_1_city_' id='label_ff_3_address_1_city_'>City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_3_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"City\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_address_1_state_' id='label_ff_3_address_1_state_'>State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[state]\" id=\"ff_3_address_1_state_\" class=\"ff-el-form-control\" placeholder=\"State\" data-key_name=\"state\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_address_1_zip_' id='label_ff_3_address_1_zip_'>Zip Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_3_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"Zip\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_address_1_country_' id='label_ff_3_address_1_country_'>Country<\/label><\/div><div class='ff-el-input--content'><select name=\"address_1[country]\" id=\"ff_3_address_1_country_\" class=\"ff-el-form-control\" placeholder=\"Select Country\" data-key_name=\"country\" aria-invalid='false' aria-required=false><option value=''>Select Country<\/option><option value='AF' >Afghanistan<\/option><option value='AX' >Aland Islands<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Saint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='VG' >British Virgin Islands<\/option><option value='BN' >Brunei<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CV' >Cabo Verde<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos (Keeling) Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czech Republic<\/option><option value='CD' >Democratic Republic of the Congo (Kinshasa)<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italy<\/option><option value='CI' >Ivory Coast<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='XK' >Kosovo<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Laos<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao S.A.R., China<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='KP' >North Korea<\/option><option value='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestinian Territory<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='CG' >Republic of the Congo (Brazzaville)<\/option><option value='RO' >Romania<\/option><option value='RU' >Russia<\/option><option value='RW' >Rwanda<\/option><option value='RE' >R\u00e9union<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='SX' >Saint Martin (Dutch part)<\/option><option value='MF' >Saint Martin (French part)<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia\/Sandwich Islands<\/option><option value='KR' >South Korea<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom (UK)<\/option><option value='US' >United States (US)<\/option><option value='UM' >United States (US) Minor Outlying Islands<\/option><option value='VI' >United States (US) Virgin Islands<\/option><option value='UY' >Uruguay<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vatican<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_1' id='label_ff_3_input_text_1'>Emergency contact and preferred contact method<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" placeholder=\"Name, relationship, and phone number\" data-name=\"input_text_1\" id=\"ff_3_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_2\" ><h3 class='ff-el-section-title'>Goals and Treatment Areas<\/h3><div class='ff-section_break_desk'><p>Please tell us what you would like to improve and which areas you would like treated.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description' id='label_ff_3_description'>Treatment areas, goals, and desired results<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description\" name=\"description\" id=\"ff_3_description\" class=\"ff-el-form-control\" placeholder=\"List the areas you would like treated and what you hope to achieve, and when you would like to start\" rows=\"3\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_3\" ><h3 class='ff-el-section-title'>Medical History<\/h3><div class='ff-section_break_desk'><p>Please share your full medical history, current medications and supplements, allergies, and any past surgeries, injuries, or hospitalizations.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_1' id='label_ff_3_description_1'>Full medical history, medications, supplements, allergies, and past surgeries, injuries, or hospitalizations<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_1\" name=\"description_1\" id=\"ff_3_description_1\" class=\"ff-el-form-control\" placeholder=\"List your medical conditions, medications and supplements, allergies, and any past surgeries, injuries, or hospitalizations\" rows=\"3\" cols=\"2\" data-name=\"description_1\" ><\/textarea><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_4\" ><h3 class='ff-el-section-title'>Contraindications Screening<\/h3><div class='ff-section_break_desk'><p>Please tell us about anything that could affect treatment safety, such as pregnancy, recent surgery, skin conditions or infections, implanted devices, or blood-thinning medication. Refusal-for-treatment policy: treatment may be refused if a contraindication makes treatment unsafe or unsuitable.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Please check any that apply to you<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_cd8ce69a158b0c72f5ac19452c70c0f9'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pregnancy or breastfeeding\"  id='checkbox_cd8ce69a158b0c72f5ac19452c70c0f9' aria-label='Pregnancy or breastfeeding' aria-invalid='false' aria-required=false> <span>Pregnancy or breastfeeding<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_65dfae00b9fb5a3461cce4727c93c086'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Recent surgery or injury in the treatment area\"  id='checkbox_65dfae00b9fb5a3461cce4727c93c086' aria-label='Recent surgery or injury in the treatment area' aria-invalid='false' aria-required=false> <span>Recent surgery or injury in the treatment area<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2a0975f62f6e0f67031f5402385636e5'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Active skin infection, rash, or open wound\"  id='checkbox_2a0975f62f6e0f67031f5402385636e5' aria-label='Active skin infection, rash, or open wound' aria-invalid='false' aria-required=false> <span>Active skin infection, rash, or open wound<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_65aef74423af16cd18f8001f7e28865f'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Implanted medical device in the treatment area\"  id='checkbox_65aef74423af16cd18f8001f7e28865f' aria-label='Implanted medical device in the treatment area' aria-invalid='false' aria-required=false> <span>Implanted medical device in the treatment area<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_245fe1d293e8f2a67bd4c2367fedb600'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Blood-thinning medication or bleeding condition\"  id='checkbox_245fe1d293e8f2a67bd4c2367fedb600' aria-label='Blood-thinning medication or bleeding condition' aria-invalid='false' aria-required=false> <span>Blood-thinning medication or bleeding condition<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5f45046a03879e7f4ef9d50476d95392'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"None of the above\"  id='checkbox_5f45046a03879e7f4ef9d50476d95392' aria-label='None of the above' aria-invalid='false' aria-required=false> <span>None of the above<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_2' id='label_ff_3_description_2'>Please explain any items you checked above<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_2\" name=\"description_2\" id=\"ff_3_description_2\" class=\"ff-el-form-control\" placeholder=\"Give details, dates, or treatment information if applicable\" rows=\"3\" cols=\"2\" data-name=\"description_2\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Refusal-for-treatment acknowledgment<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_718ed30a0324523bf169650ef2805ccd'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"I understand treatment may be refused if a contraindication makes treatment unsafe or unsuitable.\"  id='checkbox_1_718ed30a0324523bf169650ef2805ccd' aria-label='I understand treatment may be refused if a contraindication makes treatment unsafe or unsuitable.' aria-invalid='false' aria-required=true> <span>I understand treatment may be refused if a contraindication makes treatment unsafe or unsuitable.<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_5\" ><h3 class='ff-el-section-title'>Lifestyle and Previous Treatments<\/h3><div class='ff-section_break_desk'><p>Please share your current lifestyle and any previous body contouring or aesthetic treatments and their results.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_3' id='label_ff_3_description_3'>Lifestyle: exercise, diet, sleep, smoking or vaping, alcohol, and water intake<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_3\" name=\"description_3\" id=\"ff_3_description_3\" class=\"ff-el-form-control\" placeholder=\"Describe your exercise, diet, sleep, smoking or vaping, alcohol use, and water intake\" rows=\"3\" cols=\"2\" data-name=\"description_3\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_4' id='label_ff_3_description_4'>Previous body contouring or aesthetic treatments and results<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_4\" name=\"description_4\" id=\"ff_3_description_4\" class=\"ff-el-form-control\" placeholder=\"List any previous body contouring or aesthetic treatments, when they were done, and the results\" rows=\"3\" cols=\"2\" data-name=\"description_4\" ><\/textarea><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_6\" ><h3 class='ff-el-section-title'>Extra Consultation for Larger Bodies<\/h3><div class='ff-section_break_desk'><p>If applicable, please share anything that will help us plan a comfortable and suitable treatment for a larger body, including comfort, mobility, skin sensitivity, and positioning support needs.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_5' id='label_ff_3_description_5'>Comfort, mobility, skin sensitivity, and positioning support needs<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_5\" name=\"description_5\" id=\"ff_3_description_5\" class=\"ff-el-form-control\" placeholder=\"Describe any comfort, mobility, skin sensitivity, or positioning support needs\" rows=\"3\" cols=\"2\" data-name=\"description_5\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_6' id='label_ff_3_description_6'>Weight history, height and BMI if known, and medical clearance if applicable<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_6\" name=\"description_6\" id=\"ff_3_description_6\" class=\"ff-el-form-control\" placeholder=\"Share your weight history, height and BMI if known, and any medical clearance\" rows=\"3\" cols=\"2\" data-name=\"description_6\" ><\/textarea><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_7\" ><h3 class='ff-el-section-title'>Measurements and Weight<\/h3><div class='ff-section_break_desk'><p>Please share your current weight and measurements, including units, so progress can be tracked.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_7' id='label_ff_3_description_7'>Current weight and height, including units<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_7\" name=\"description_7\" id=\"ff_3_description_7\" class=\"ff-el-form-control\" placeholder=\"Enter your current weight and height, and state the units (for example lb\/kg and inches\/cm)\" rows=\"3\" cols=\"2\" data-name=\"description_7\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_8' id='label_ff_3_description_8'>Measurements: waist, hips, abdomen, arms, and thighs, including units<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_8\" name=\"description_8\" id=\"ff_3_description_8\" class=\"ff-el-form-control\" placeholder=\"List each measurement with its unit, for example waist, hips, abdomen, arms, and thighs in inches or cm\" rows=\"3\" cols=\"2\" data-name=\"description_8\" ><\/textarea><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_8\" ><h3 class='ff-el-section-title'>Custom Per-Client Pricing Plan<\/h3><div class='ff-section_break_desk'><p>Pricing is customized for each client and will be confirmed at consultation. Please note your budget or any pricing questions below.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_9' id='label_ff_3_description_9'>Recommended treatment plan and number of sessions (to be confirmed at consultation)<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_9\" name=\"description_9\" id=\"ff_3_description_9\" class=\"ff-el-form-control\" placeholder=\"Describe the recommended treatment plan and number of sessions, to be confirmed at consultation\" rows=\"3\" cols=\"2\" data-name=\"description_9\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_10' id='label_ff_3_description_10'>Price per session and package or total estimate (to be confirmed at consultation)<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_10\" name=\"description_10\" id=\"ff_3_description_10\" class=\"ff-el-form-control\" placeholder=\"Enter the price per session and any package or total estimate, to be confirmed at consultation\" rows=\"3\" cols=\"2\" data-name=\"description_10\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_11' id='label_ff_3_description_11'>Pricing notes, budget, deposit, or payment plan<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_11\" name=\"description_11\" id=\"ff_3_description_11\" class=\"ff-el-form-control\" placeholder=\"Add pricing notes, your budget, deposit, or payment plan preferences\" rows=\"3\" cols=\"2\" data-name=\"description_11\" ><\/textarea><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_9\" ><h3 class='ff-el-section-title'>Liability Waiver for Treatment<\/h3><div class='ff-section_break_desk'><p>I understand that body contouring results vary, that I must follow aftercare instructions, and that I will tell the clinic about any pain, discomfort, or concern during or after treatment. I accept responsibility for following the agreed treatment and aftercare plan.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Liability waiver acknowledgment<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_6a3124f8a0c6ec4bc9d6e0eb8be7e1a5'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"I have read and agree to the liability waiver for treatment above.\"  id='checkbox_2_6a3124f8a0c6ec4bc9d6e0eb8be7e1a5' aria-label='I have read and agree to the liability waiver for treatment above.' aria-invalid='false' aria-required=true> <span>I have read and agree to the liability waiver for treatment above.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_2' id='label_ff_3_input_text_2'>Signature \u2014 type your full name (liability waiver)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" placeholder=\"Type your full name as your signature\" data-name=\"input_text_2\" id=\"ff_3_input_text_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_datetime_1' id='label_ff_3_datetime_1'>Date (liability waiver)<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date (liability waiver) Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_1\" id=\"ff_3_datetime_1\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_1\"  aria-invalid='false' aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_10\" ><h3 class='ff-el-section-title'>Optional Model Waiver (If Applicable)<\/h3><div class='ff-section_break_desk'><p>Only complete this section if you agree to be a model for before-and-after photos or promotional use. If this does not apply to you, leave this section blank.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Model waiver consent (optional)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_d8f22a4d85736c022191cf7e228aaf9a'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"I agree to be a model and allow before-and-after photos to be used for promotional purposes.\"  id='checkbox_3_d8f22a4d85736c022191cf7e228aaf9a' aria-label='I agree to be a model and allow before-and-after photos to be used for promotional purposes.' aria-invalid='false' aria-required=false> <span>I agree to be a model and allow before-and-after photos to be used for promotional purposes.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_3' id='label_ff_3_input_text_3'>Signature \u2014 type your full name (model waiver, if applicable)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" placeholder=\"Type your full name as your signature\" data-name=\"input_text_3\" id=\"ff_3_input_text_3\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_datetime_2' id='label_ff_3_datetime_2'>Date (model waiver, if applicable)<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date (model waiver, if applicable) Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_2\" id=\"ff_3_datetime_2\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_2\"  aria-invalid='false' aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_11\" ><h3 class='ff-el-section-title'>Appointment Reminders and Follow-Up Consent<\/h3><div class='ff-section_break_desk'><p>Please let us know if we may remind you of appointments and follow up with you after appointments.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Appointment reminder and follow-up consent (optional)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_8351496543e8dd09a0fafd5c5dc01ae9'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"I agree to receive appointment reminders and post-appointment follow-up from The Aestheticist Skincare Solutions.\"  id='checkbox_4_8351496543e8dd09a0fafd5c5dc01ae9' aria-label='I agree to receive appointment reminders and post-appointment follow-up from The Aestheticist Skincare Solutions.' aria-invalid='false' aria-required=false> <span>I agree to receive appointment reminders and post-appointment follow-up from The Aestheticist Skincare Solutions.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Promotional and seasonal offers consent (optional)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_bae2cc58e01a850d04b1d812fdb0648d'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Yes, I would like to be contacted with promotional and seasonal sales and service offers.\"  id='checkbox_5_bae2cc58e01a850d04b1d812fdb0648d' aria-label='Yes, I would like to be contacted with promotional and seasonal sales and service offers.' aria-invalid='false' aria-required=false> <span>Yes, I would like to be contacted with promotional and seasonal sales and service offers.<\/span><\/label><\/div><\/div><\/div><div class='ff-form-inline-style' hidden><style>form.fluent_form_3 .ff-btn-submit:not(.ff_btn_no_style) { background-color: var(--fluentform-primary); color: #ffffff; }<\/style><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\"  aria-label=\"Submit Form\">Submit Form<\/button><\/div><\/fieldset><\/form><div id='fluentform_3_errors' class='ff-errors-in-stack ff_form_instance_3_1 ff-form-loading_errors 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Please complete this body contouring client consultation form below. 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