Consultation - Body by Yashi

718-913-2365
info@bodybyyashi.com

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Our Services
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Create Recovery Box
Consultation
Contact Us

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Our Services
Training
Shop
Create Recovery Box
Consultation
Contact Us

Our Services
Training
Shop
Create Recovery Box
Consultation
Contact Us

Your Information – Step 1 of 7

Please complete this form to book services at our New York Studio or to book mobile services in NY or Miami (lymphatic massages, IV hydration, private nursing, meal prep, etc). PLEASE BE READY TO MAKE YOUR DEPOSIT AT THE COMPLETION OF THIS FORM. MAKING A DEPOSIT IS THE ONLY WAY TO RESERVE YOUR SPOT.

Name *

First

Last

Date of Birth *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone Number *

Gender *

Select an option

Age *

Do you have any allergies? *

Yes
No

List all allergies *

Are you taking any medication(s) or vitamin(s)? *

Yes
No

List all medication(s) or vitamin(s) *

Do you have any pre-existing health issues/diseases? If yes, please explain *

Are you pregnant or think you may be pregnant? *

Yes
No

Did you have surgery or are planning to have surgery? *

Yes
No

Name of Surgeon *

Country or State *

Date of procedure(s) *

Type of procedure(s) *

Liposuction
BBL (Fat Transfer)
Tummy Tuck
Breast Augmentation
Breast Lift
Other

Select all that apply

Are you interested in receiving services at our New York Studio? *

Yes
No

Select all that apply: *

Post Op Care (Lymphatic Massages)
Seroma Treatment
Tape Method
Advanced Post Op Care
Counseling
Body Contouring
Teeth Whitening
IV Vitamin Infusions
Yoni Steam
Brazilian Wax
Vajacial
O-Shot
PRP (BBL & Hair Restoration)
Keloid Shot
Other

Body Contouring *

Sauna Wrap
Non-Invasive Lipo (Cavitation)
Cellulite Reducer
Butt Plumping
Skin Tightening
Lipo Laser

Post op care rates *

Select a package

How many sessions do you require? *

Advanced post op care rates *

Select a package

How many sessions do you require? *

IV vitamin infusions *

B12 $25
Glutathione $95
Pure Hydration $150
Immunity (Pre Op) $175
Snatched $199
BBL Booster $199
Glow (Skin) $200
Glow (Hair) $215
Swell Less (Post Op) $225
Vagi $250

Select all that apply

Are you interested in our mobile services? *

Yes
No

Where would you like to receive mobile services? *

New York (NYC, Queens, Brooklyn, Bronx, Long Island)
Miami (West Miami, South Miami, Coral Gables)
Both

Select all that apply: *

Post Op Care (Lymphatic Massages)
Seroma Treatment
Tape Method
Private Nursing (Miami Only)
IV Vitamin Infusions
Meal Prep (Miami Only)
Other

Mobile post op care rates *

Select a package

How many sessions will you require? *

Will the provider need to walk up one or more flight of stairs? *

Yes
No

+$25 Additional

Do you have a pet(s)? *

Yes
No

Nursing rates *

Select an option

How many hours of care will you need? *

4 HOUR (MIN)

How many days will you require assistance? *

Car Service: Please read the statement below: *

I agree
I will not require additional rides

If you require private duty to begin directly after the completion of surgery, (1) one ride to place of stay is included. Any additional rides require a $45 fee (per ride) and is at the discretion of your caregiver.

IV vitamin infusions *

B12 $25
Glutathione $95
Pure Hydration $150
Immunity (Pre Op) $175
Snatched Drip $199
BBL Booster $199
Glow (Skin) $200
Glow (Hair) $215
Swell Less (Post Op) $225

Select all that apply +$25 travel fee

Meal prep rates (delivery included) *

5 for $100
10 for $165
Other

How many meals will you require? *

List food preferences and food allergies *

When would you like service(s) to begin? *

Select a date

Recovery Address *

Is this a Recovery House or Hotel? *

Yes
No

Name of RH or Hotel *

Please check with RH if outside providers are allowed PRIOR to booking.

To help us serve you better, please list any additional information.

A non-refundable deposit is required to book and is applied to balance. ALL SALES ARE FINAL: There are no refunds or exchanges on any products or services. *

Type full name

Signature *

Name

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