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Cosmetic Injectable
Pre-Consultation Questionnaire

Welcome and thank you for considering MY BODY VIBES for your cosmetic injectable treatments. To make the most of your upcoming consultation and to tailor our discussion to your specific needs and expectations, we kindly ask you to complete this pre-consultation questionnaire.

Part A:Anti-wrinkle Injection Concerns

Which of the following areas are you considering for anti-wrinkle injections? (Select all that apply)
What are your goals with anti-wrinkle injections? (Select all that apply)

Part B:Dermal filler Injection Concerns

Which of the following areas are you considering for dermal filler injections? (Select all that apply)
What are your goals with dermal filler injections? (Select all that apply)

Previous Cosmetic Procedures

Have you had any cosmetic injectable treatments before?

Lifestyle and Skin Care

General Health Information

Travel Plans: Do you have any travel plans, particularly involving air travel, within the next 14 days? Dermal filler treatments require a specific timeframe without air travel to ensure proper healing and minimize complications.
Pregnancy: Is there any possibility that you are currently pregnant? It's crucial for us to know as certain cosmetic treatments, including injectables, are not recommended during pregnancy.

Treatment Preferences and Concerns

What is your level of tolerance for downtime or recovery associated with treatments?
How soon are you hoping to see results from the treatment?

Thank you for taking the time to complete this questionnaire. We look forward to discussing your aesthetic goals and how we can help achieve them.

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