315-985-8556
bodysiense@gmail.com
54 W. Main St. Little Falls, New York
Spa Services
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Cryoskin
Body Evaluation
Float Pods
Infrared Sauna
Massage
Hair Removal
NUFACE
Facials
Eyelashes
Energy Work
Hand & Foot
Packages
Gift Cards
Financing
Location
About
Open menu
Our Team
Contact
Menu
Spa Services
Open menu
Cryoskin
Body Evaluation
Float Pods
Infrared Sauna
Massage
Hair Removal
NUFACE
Facials
Eyelashes
Energy Work
Hand & Foot
Packages
Gift Cards
Financing
Location
About
Open menu
Our Team
Contact
Book Now
Spa Services
Open menu
Cryoskin
Body Evaluation
Float Pods
Infrared Sauna
Massage
Hair Removal
NUFACE
Facials
Eyelashes
Energy Work
Hand & Foot
Packages
Gift Cards
Financing
Location
About
Open menu
Our Team
Contact
Menu
Spa Services
Open menu
Cryoskin
Body Evaluation
Float Pods
Infrared Sauna
Massage
Hair Removal
NUFACE
Facials
Eyelashes
Energy Work
Hand & Foot
Packages
Gift Cards
Financing
Location
About
Open menu
Our Team
Contact
Book Now
Body Evaluation Questionnaire
One size, does not, fit all.
A comprehensive plan, based on your goals.
Fill out our Body Evaluation Questionnaire, tell us about your goals, set up an appointment for a FREE body evaluation and come meet us!
First Name
Last Name
Email
Date Of Birth
Have you ever tried any other aesthetic procedures in the past?
Yes
No
If "yes", which ones?
How did you hear about Cryoskin?
Friend/Family
TV/Radio
Internet
Other
Background Information (please check al l that apply)
Botox in the past 30 days
Surgery in the past 6 months
Pregnant and/or breastfeeding
Kidney and/or Liver disease
Lymphatic disorders
Severe allergy to cold
Eczema, rashes, or dermatitis
Circulatory disorders
Mesh inserts
HIV/AIDS
Using topical antibiotics
Cold-related Illness
Bacterial/viral skin infection
Impaired skin sensation
Hernia in desired treatment area
Fillers in the past 90 days
Implants in desired treatment area
Active/Past Cancer
Cardiovascular Disease
Uncontrolled Diabetes
Severe Raynaud's Syndrome
Open or infected wounds
Pacemaker/metal implants
Incision scar(s) in the desired area
Body piercings in the desired area
Lower Limb schemia
Progressive diseases (MS, ALS, etc.)
Wound healing disorders
Known sensitivity to propylene glycol
How many times per week do you exercise?
How many glasses of water do you drink per day?
How would you rate your diet?
Extremely healthy
Generally healthy
Needs improvement
Check off your areas of concern (check all that apply)
Neck
Chin
Arms
Back
Stomach
Upper Legs
Lower Legs
Have any other treatments/diets/exercise regimens helped these areas?
Yes
No
What is your goal with Cryoskin?
Do you have any questions about Cryoskin?
Send
After filling out the form, please schedule a free body evaluation with a therapist.
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