Personal Data: (Items with * should be filled in)
* Name
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* Gender
 ： Male　 Female
* Age
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* Tel
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* E-mail address
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Correspondence address
* If you want to receive the latest information on Marie France Bodyline.
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* Convenient time to contact me:
Monday ~ Friday
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Or Saturday ~ Sunday
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* The nearest Centre
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【PART I】
    
1.
： Area which you want to slim down?
    Waist      Tummy        Hip
    Thighs     Arms
   
Others
2.
： Your Ideal weight and inch loss?
    lbs  /  overall inches         
    body contouring
3.
： Have you ever tried any slimming treatments before?
    no
    yes, the result was good
    yes, but not satisfactory
4.
： Which of the following treatments have you tried?
    Slim Tunnel
Infrared electric blanket
M6
    Slimming product external application
Fat Suction Machine
Lymphatic drainage massage
    Never
【PART II】
    
1. 
   Which of the following treatments provided by
Marie France Bodyline are you interested in most?
(can select more than 1 choice)
    MTS Mirco-needle Wrinkle-removal Treatment
    OP Active Fat-removal Treatment
    RF60 Optical Radio-frequency Rapid Slimming Treatment
    Diode Radio-frequency Fat-removal Technology
    SUM Slimming Treatment
    Elos Infrared Radio-frequency Rapid Tightening Treatment
    Unique Aroma Acupuncture point Belly Fat-removing Treatment
I hope to receive the latest information on and preferential activities of Marie France Bodyline free of charge.
Confidentiality: Marie France Bodyline will use your information for providing slimming consultation and information to you only. If you do not need to receive related information any more, you can cancel at any time.
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