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 interest in Sculptology! We’ll be contacting you once reviewed.Sincerely,Sculptology Team
