Body Contouring Inquiries

Although there is no substitute for a face-to-face consultation, we can often help determine whether you are a suitable candidate for a specific procedure by viewing your photos.

It is important that you send us images of sufficient quality so that we can adequately assess your cosmetic concerns. Please review the General Photo Taking Guidelines at the bottom of this form prior to uploading photos.

Legal Name *
Preferred Name or Nickname *
Date of Birth (MM/DD/YYYY) *
E-mail *
Telephone *
Zip Code *
How do you prefer to be contacted? *
Do you already have a consultation scheduled? *
CoolSculpting (and Liposuction) can target stubborn fat in the areas that bother you the most. Please indicate the areas in which you would like to reduce fat (select all that apply). *
CoolTone is used for toning, strengthening and firming up the buttocks, legs, and abdomen. Please indicate the areas you would are interested in treating (select all that apply). *
Please provide details regarding the areas of concern you selected above. *
Please provide details regarding any past treatments you've had to address these concerns. When was the last treatment? What were your results? *
Use the above "browse" button to upload files. To select multiple files, use the Control (Windows) or Command (Mac) and click on each file you'd like to upload prior to clicking "Add". To select multiple photos from a mobile device, please select all photos prior to clicking "Add". Once you click Add, you will not be able to upload more photos on the same form. If you accidentally click Add and want to add more photos, please remove the photo then re-add them. Limit: 8MB
Upload Photos. *
Please don't use any spaces or special characters (# % & { } \ < > * ? / $ ! '" : @) in the name of the image files.
General Photo Taking Guidelines
GENERAL: Have someone take the photos for you or use a timer. Selfies are not acceptable since they distort proportions. BODY PHOTOS: Pinch the area and pull away from the body. CHIN REGION PHOTOS: Take one photo facing the camera, one tucking your chin to your chest and do the same with profile photos.
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