Body shaping Question Title * 1. What is your gender? Female Male Rather not answer OK Question Title * 2. How old are you? OK Question Title * 3. What is your current weight in pounds? OK Question Title * 4. What is your current height? OK Question Title * 5. Please choose all the area you would like to target Tummy Love handles Arms Hips Other (please specify) OK Question Title * 6. What is bothering you? Fats Saggy skin both OK Question Title * 7. What have you tried before? OK Question Title * 8. Do you have one of the followings? Currently taking blood thinner Uncontrol diabetes Skin problems that delay natural healing Hernia I am very healthy Any other chronic diseases (please specify) OK Question Title * 9. How do you describe your lifestyle? Extremely strict: I count my calories of every meal and exercise every day Very Strict: I watch I eat and exercise 3 times weekly Strict: I think before I eat and exercise 3 times weekly Relaxed: I watch my weight and exercise when time permit Very relaxed :) OK Question Title * 10. Have you heard about any of the following? please check all applicable choices Coolsculpting or Coolshaping Cryolipolysis Radio frequency and Infrared Fat cells apoptosis Kuma Shape Sculpsure or Velashape lipo dissolving injection OK Question Title * 11. What is your budget? 500 3000 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 12. How did you hear about us? Google search Facebook ad Instagram ad Printed media Word of mouth OK Question Title * 13. Please fill in your contact information to receive the $100 discount coupon First name * Last name Email Address * Phone Number * OK Question Title * 14. How do you like us to contact you? Phone call Email Text message OK DONE
