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Body Contouring Client Intake & Goals Assessment

A pre-consultation intake for body contouring and non-surgical fat reduction clients, covering treatment areas of interest, goals, health history flags, and expectations. An AI follow-up interview explores what's driving the request and probes any flagged health history so providers walk into the consultation prepared, not surprised.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

14 questions · ~7 min
Q01
Message

Welcome! Before your body contouring consultation, we'd like to understand your goals, health history, and expectations so we can recommend the right treatment plan. This takes about 5-6 minutes, and everything you share stays confidential with your care team.

Q02
Multiple ChoiceRequired

Which areas are you hoping to address? (Select all that apply)

  • Abdomen
  • Flanks / love handles
  • Thighs
  • Arms
  • Back
  • Chin / neck
  • Buttocks
Q03
Multiple ChoiceRequired

What's the primary result you're hoping to achieve?

  • Reduce stubborn fat
  • Tighten loose or sagging skin
  • Smooth cellulite
  • Improve overall body contour or shape
  • Build muscle definition
  • Not sure yet - exploring options
Q04
Multiple ChoiceRequired

Do any of the following apply to you? (Select all that apply — this helps us flag anything we should discuss before treatment)

  • Currently pregnant or breastfeeding
  • Pacemaker or implanted electronic device
  • History of blood clots or clotting disorder
  • Active skin infection or open wound in the treatment area
  • Recent surgery in the treatment area (last 6 months)
  • Autoimmune condition
Q05
Long Text

Please list any current medications, supplements, or medical conditions we should know about (e.g., blood thinners, diabetes, recent significant weight changes).

Q06
Multiple ChoiceRequired

Have you had body contouring treatments before (at our practice or elsewhere)?

  • No, this is my first time
  • Yes, one treatment
  • Yes, multiple treatments
  • Not sure what counts as body contouring
Q07
Opinion ScaleRequired

How dramatic a change are you expecting to see in the treated area?

Scale: 1 – 7
Min:Very subtle refinementMax:Dramatic transformation
Q08
Rating ScaleRequired

How important is having little to no downtime after treatment?

Range: 1 – 5
Min:Not importantMax:Extremely important
Q09
Multiple ChoiceRequired

When are you hoping to start treatment?

  • As soon as possible
  • Within the next month
  • 1-3 months from now
  • Just researching, no timeline yet
Q10
AI Interview

Explore what's driving this respondent's interest in body contouring right now — a specific event, a plateau despite diet and exercise, or something else — and how they define 'success' in concrete terms (clothing fit, photos, confidence). If they flagged any health history item, gently confirm the details so the provider has enough context before the consultation. If their stated expectations sound more dramatic than a single non-surgical treatment typically delivers, note this clearly so the provider can set expectations early.

Q11
Consent

Progress photo consent

Q12
Multiple Choice

What's your age range?

  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65+
  • Prefer not to say
Q13
Multiple Choice

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q14
Message

Thank you for sharing this with us! Your answers help your provider tailor a treatment plan and consultation just for you — this information stays in your confidential client file and is only used for your care team's planning.

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • Includes a dedicated multiple-choice question flagging health history conditions, paired with a open-text follow-up for medications/supplements/conditions so providers aren't caught off guard
  • Uses an AI follow-up interview to explore what's actually driving the client's interest in body contouring right now, going beyond static answer choices
  • Captures both aesthetic expectations (rating-scale on how dramatic a change they expect, rating on downtime tolerance) and logistics (timing, treatment areas, prior treatments) in one flow
  • Includes explicit progress photo consent and demographic questions (age range, gender) alongside a warm welcome and closing conversational message, so the intake feels guided rather than clinical-cold

Jotform

Body Contouring Client Intake Form Template

A static, fielding-ready intake form built specifically for body contouring clients, likely covering treatment areas and basic health history in a fixed question set. As a form builder, Jotform lets you customize fields and branding but does not conduct any live follow-up conversation with respondents.

What it does well

  • Purpose-built for body contouring intake, so field naming and flow match the use case
  • Easy drag-and-drop customization and integration with Jotform's broader form ecosystem
  • Likely supports e-signature/consent widgets given Jotform's general form feature set

Where it falls short

  • Static question set with no adaptive follow-up probing on flagged health history or motivations
  • No automated per-response quality scoring or AI-generated consultation-ready reports
  • No transparent, inspectable AI prompts since there is no AI interview component

SurveySparrow

Body Contouring Client Intake Form Template

A conversational-style, fielding-ready template targeted at the same body contouring intake use case, leveraging SurveySparrow's chat-like survey format. It likely presents questions one at a time for a friendlier feel, but the questions themselves remain fixed rather than adapting based on answers.

What it does well

  • Conversational one-question-at-a-time format may feel more approachable to clients
  • Template is niche-matched to body contouring, reducing setup work
  • Part of a broader survey platform with reporting/analytics dashboards

Where it falls short

  • No adaptive AI follow-up interview to explore motivations or dig into flagged health conditions
  • No voice AI interview or guided screen-share task option
  • Lacks automated per-response quality scoring or transparent AI prompt methodology

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

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