New Customer Information

First Name Last Name
Cell Phone Home Phone Work Phone
Street Address
City State Zip
Email Address Date of Birth (dd/mm/yyyy)

How did you hear about Suddenly Slimmer Atlanta?
Star 94 FM Q100 FM Kicks FM Dave FM
True Oldies FM The River FM The Fish FM **Other Radio (Specify Below)
Internet **TV Shows (Specify Below) ** TV Ads(Specify Cable Co.) *Referrals Friends and Family
Skirt Magazine Atlanta Parent ** Other Print (Specify below) Other**
*If referred, By whom? **If other, what source?:
Answers to health questions are needed for our records only and are kept confidential
Are you under a doctor's care? Yes No
If yes, for what reason:
Are you taking any drugs or medication at this time? Yes No
If yes, please state reason for taking each:
Do you have any communicable diseases? Yes No
If yes, what type:
Have you had any surgical operations or broken bones within the last 9 months? Yes No
If so, please provide brief details:
Are you pregnant? Yes No
NOTE: If you are pregnant, we require written permission from your doctor to wrap you
Do you have any respiratory or circulatory problems? Yes No
If yes, what type?
Do you have any health problems not covered above i.e. back/knee problems? Yes No
If yes, please explain:
 
Do you take multi-vitamins with minerals? Yes No
If yes, brand name:
Are you currently on a diet? Yes No

Current Weight:

Ideal Weight Goal:
Do you exercise regularly? Yes No
If so, how often?

Current Dress/Pant Size:

Ideal Dress/Pant Size:


Terms and Conditions

I understand that I am wrapped at my own risk and that Suddenly Slender, The Body Wrap, its Licensed Centers, Center Owners, Licensor, Agents, Management and Employees assume no liability of any kind whatsoever.

I understand that if I am currently pregnant, under the care of a physician, or have recently had major surgery, I must provide written permission from my attending physician prior to receiving body wrap services. Wraps cannot be administered to individuals with infectious or contagious diseases or individuals with open wounds, cuts, or recent waxing for hair removal.

If I need to change or cancel my appointment, I must contact Suddenly Slimmer no later than 24 hours prior to the scheduled date and time. Failure to do so will result in a charge of 50% of the service price to your credit card (or one wrap removed for package customers) to cover the cost of materials and labor.

I understand that I should arrive 10 minutes prior to my appointment time. If I am more than 15 minutes late for my appointment time, I understand that Suddenly Slimmer may need to cut my service short, so as to not inconvenience other customers. In this case, Suddenly Slimmer may choose to measure me in only a few of my key areas or not measure me at all. If I am excessively late, I understand I may not have the full time in the wrap. In all cases where full measurements can't be done, the guaranteed inch loss on the first wrap will be waived. If I choose not to proceed with the wrap, or am too late to even be wrapped, I understand that I will be charged 50% of the wrap's value, or have a wrap deducted from my package.

Suddenly Slimmer reserves the right to waive the guaranteed inch loss for people with extremely toned, fit bodies or customers of 115 pounds (size 2) or less. We recommend that people with these types of bodies still enjoy the wraps for the benefits received to the skin and lymph systems, as well as inch loss in needed areas.

By checking this box I agree to all Suddenly Slimmer Terms & Conditions.

 

 
Monthly Specials