AZ Body Werx

Intake Forms

Please complete the Entire form below Before your upcoming appointment.

Thank you!

AZ Body Werx

Intake Form

1655 W Chandler Blvd

Unit 1, Studio 22

Chandler, AZ 85224

Inside Beauty Lounge Bar

Demographic Information:

We Offer Package Pricing for Each Treatment!

Lifestyle Info:

Soreness, Stiffness, Discomfort

Please review each question carefully, and answer each one to the best of your knowledge. It is important to know your complete medical history when completing the medical portion. We am not held responsible if you do not provide your complete history prior to treatment. If you are unsure of any medical issue, please contact your physician prior to proceeding with treatment.

Medical History & Contraindications

Diabetes Info

Medical History 2/3

Medical History 3/3

Medication

Physician Info

Additional Information About Results

I, (hereinafter, throughout each form, referred to as "Client", "I", "my", "you", "your", and "you're") understand the results are permanent based on lifestyle, and age.

We, AZ Body Werx, (hereinafter referred to as "Company" and "we") don't guarantee any results because we can't control what people do when they leave the session, and we can't be held the responsible for that.

Sometimes there are health issues we were not informed of prior to your treatment, we can't be held responsible for this either. This is why it’s very important to know your complete medical history; past and present when completing the intake forms.

*If you should later develop any condition, please inform us, and consult with your physician before continuing with the treatment. We would require a "release to treat" letter, on the doctors letterhead, from your providing physician before we schedule your next session.

There have been many times we are informed of a current thyroid disorder, type II diabetes, or an immune disorder.  Although this is covered on the medical history forms, it's been withheld.

By withholding any medical information, medical problems, or any medical conditions listed or not listed on the intake forms can be the factor of the treatment not working well.

Please don’t wait 7 sessions in to let us know, that won’t be on us. We did what you paid for, and we cannot control what happens when our client(s) walk out the door)

For Example; If you decide to stop for Starbucks, fast food for dinner, or go out for drinks. This will cause you not to have results. This is not on us if you choose not to have well-balance meals. You have to limit your carb and refined sugar and processed foods. 

Pre & post session instructions are recommended to follow, these can be found on the website; visit: https://azbodywerx.com/post-treatment

If you have questions, please feel free to message AZ Body Werx, we are here for you.

I understand results may vary depending on individual factors, and are not a guarantee, including but not limited to skin type, patient compliance, patient health background, and history, and individual response to treatment.  It can take anywhere from 4-12 sessions to obtain your desired results depending on your lifestyle, age. This is normal timeframe for body sculpting results. You may have to make some adjustments in your lifestyle in order to reach those goals, very minimal change. You can do it!

I will ensure I am well hydrated starting two days prior to my session by drinking 1-2 liters each day, three days prior, leading up to the appointment, and on the day of my session.

Everyone's body is different, some will show results the first day, and others it may take up to 7-14 days. It all depends on your lifestyle and if you keep hydrated, and do some form of exercise even if it’s a brisk walk. Doing a brisk 30 min walk after each session daily,  or every other day is another way to gain the optimal results we want for you. We recommend you to follow aftercare instructions in order to obtain optimal results. After each session, the work during the session will continue to release the destroyed fat cells through your lymphatic system, and urine. It is crucial to drink up to ½ your body weight in water daily, if you can’t drink that much at least drink 64 oz a day to help push it out though your system. The more water you drink prior, during, and after is the key to your best results.

If you have a waist trainer, I recommend you bring to every session, we will put this on after each session. If you do not have one, let me know, we recommend you buy one, and it be put on immediately after the session, and wear it as much as possible. If you cannot find one, please let me know prior to your session.

Once you have received the results you desire, you can go on a monthly maintenance schedule*, and come in and have session; *Subsequent visits are subject to additional charges per visit which depend on the amount of work needed.

It's important to keep a healthy lifestyle so you do not go back to the old ways. We recommend you work with our personal trainer, as she will help you maintain and control well-balanced meal plan.  She works with me; this is why I recommend you speak with her. She will assist you in creating a meal plan, shopping list, and exercise schedule. All that works best for you and will only result in the best outcome for your goals. She has very reasonable plans. 

I understand I am responsible for all aftercare recommended to me in order for me to obtain optimal results, and I understand I must be consistent, and dedicated in maintaining a well-balanced meal, and exercise. 

The more consistent, and dedicated you are with well-balanced meals, and exercise you should not have any issues with treatments and getting the results you desire!

Body Treatment Aftercare Instructions

Recommendations prior to starting your first session, and during treatment process:

- Prior to starting your first session, and during each 3-day period following your treatment, we recommend you drink 2-3 liters of water a day.

- Water, and hydration is key to this process being effective.

- To maximize the effectiveness of your sessions, it is best to restrict products that impact the lymphatic flow during the program. Please avoid caffeine, alcohol, and sugar in large amounts.

- We recommend eating a healthy diet to stabilize the fat, and inches loss you obtain during the program.

- Always consult with your physician before beginning any new health & diet program.

- Always inform us if you have a change in health status or experience any unusual symptoms during your program.

- We recommend additional daily exercise to stimulate lymphatic flow. This includes low impact workouts, brisk walking, swimming or cycling during this process. Adding this activity to your ongoing lifestyle will help stabilize your weight and fat loss.

- We recommend that you schedule your sessions while you are not on your menstrual cycle as an increase in certain hormones during this time causes your body to retain water. Also, immediate results may not be seen due to bloating.

- We concentrate this treatment on one body area during each session. "Time on Target" will achieve maximum results.

- Treatments can be done in as early as every 3 days.

- Let us know if your digestive process is affected in any way during a session (constipation/diarrhea). It's a rare occurrence.

- You can not have these treatments if you are pregnant. If you should become pregnant, please inform us immediately!

Sign & Consent

AZ Body Werx

Contact Info

1655 W Chandler Blvd Unit 1 Studio 22, Chandler, AZ 85224

(480) 605-1500

Hours of Operation

Mon - Fri | 9:00 AM - 5:00 PM
Sat | 9:00 AM - 3:00 PM

Sun | Closed


We offer flexible hours to fit your busy schedule!

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