Bronze Bodies
New Customer Info Form
Full Name *
Phone *
Address *
Email *
No. of Sessions Purchased *
Please Tick the following boxes to confirm the following.
Are you currently taking any medications? *
Do you have any existing pigmentation conditions? *
Are you wearing any creams or lotions? *
Have you exfoliated with an exfoliating body polish of oils? *
Are you wearing any deodorants or perfumes? *
Do you have any know skin allergies? *
Are you wearing any moisturizers? *
How did you hear about BRONZE BODIES? Please tick appropriate one: *
Click here to indicate that you have agree to the terms and conditions agreement and are over the age of 18. *
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