1) Click on one of the links below that applies to the treatment you'll be
receiving.
Acupuncture ,
Body Care,
Chemical Peel,
Hair Removal /
Waxing,
Light / Sound
Therapy,
Lipoplasty RF/Lipolift,
Massage,
Microdermabrasion,
Nutritional
Counseling +
Consent Form,
Nutritional
Counseling [en
Espanol],
Nutritional
Counseling - By Phone,
Nutritional
Counseling - By Phone
[en Espanol],
Skin Care
+ Consent Form
Please
e-mail or
call us if you cannot find the appropriate
form corresponding to your treatment.
2) Save the Form to Your Computer
3) Fill Out the Information in the Black Lined Boxes
4) When You're Finished Filling the Form Out, Save the Form Again
5) Send Us Your Completed Form by attaching it to an e-mail (info@leselements.com)
or print it & fax it to us: (727) 343-5139
