Vanquish Client Intake Form

Please completely fill out the form or download the form, print, fill out, and bring with you to your appointment.

Vanquish Client Intake Form Download
[ARForms id=105]
  • GENERAL PATIENT RECORD
  • TREATMENT CONSIDERATIONS

    You are scheduled for a series of non-invasive treatments with the BTL VANQUISH ME.
    Check the following boxes if you agree:

  • Please answer whether you currently have or have had any of the following:

  • If you answered YES to any of these questions, please specify:

    For the full range of contraindications, warnings and cautions, consult your treatment provider.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY