[vc_row css=”.vc_custom_1503903351879{padding-top: 30px !important;padding-bottom: 30px !important;}” el_class=”cg-form-outer”][vc_column][vc_row_inner][vc_column_inner width=”2/3″][ultimate_heading main_heading=”Pre Treatment Customer Questionaire” main_heading_color=”#101010″ sub_heading_color=”#101010″ alignment=”left” main_heading_font_size=”desktop:26px;” main_heading_margin=”margin-bottom:15px;” sub_heading_font_size=”desktop:14px;” sub_heading_line_height=”desktop:24px;” main_heading_style=”font-weight:bold;” margin_design_tab_text=””]If you have been directed to this page its becuase one of our consultants have spoken to you already and offered you a time and date for your appointnent.

Please either complete the online form or download the pdf or word document. Once received if we have any questions we will be back in touch.

LA Lipo Customer Services[/ultimate_heading][/vc_column_inner][vc_column_inner width=”1/3″][vc_btn title=”Download Form” color=”warning” size=”lg” align=”center” i_icon_fontawesome=”fa fa-file-text” button_block=”true” add_icon=”true” link=”url:%2Fwp-content%2Fuploads%2F2017%2F08%2FCustomer-Data-form.docx|||”][vc_empty_space height=”10″][vc_btn title=”Download Form” color=”success” size=”lg” align=”center” i_icon_fontawesome=”fa fa-file-pdf-o” button_block=”true” add_icon=”true” link=”url:%2Fwp-content%2Fuploads%2F2017%2F08%2FCustomer-Data-form.pdf|||”][/vc_column_inner][/vc_row_inner]

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Health and Lifestyle

  • Contraindications

  • Do you have any of the following?

  • By pressing submit, you agree that we can contact you via the supplied details. We promise to only use your details to contact you in relation to this specific enquiry. Our full Privacy Policy
[/vc_column][/vc_row]