Candidate Form Do you get minimal results from exercise and dieting? * Yes No Are you within 5 to 35lbs of your goal weight for your height? * Yes No Would you like to schedule a FREE consultation with Manitoba’s Only Masters™ level Coolsculpting® Technician? Galina has performed well over 4000 Coolsculpting® treatments to date. * Yes No Name * First Name Last Name Phone * Country (###) ### #### Email * What area(s) are you interested in permanently removing fat from? Abdomen Flanks Bra roll(s) Under Arms Puffs (arm pit/tank top bulge) Inner Thigh Outer Thigh Banana Roll (rear thigh) Saddle Bags (side thighs) Male Chest Thank you for your time! We’ll be contacting you once have reviewedSincerely,Sculptology Team
