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Recommended Treatments

First name

Last name

Phone

Birthday

Year

Month

Day

What is your age?

18-24

25-34

35-44

45-54

55-64

65+

Which statement best reflects how you would like to look and feel?

I want to look less tired

I want to look less angry

I want more defined and countoured features

I want to improve lax skin, fine lines, wrinkles

none of the above

Which area of your face is your main priority?

forehead

eyes

undereyes

cheeks

jawline

full face

neck

face and neck

Which of the following is your top concern?

Volume loss

sunken appearance

jowel formation and laxity

wrinkles

fine lines

Enhance my face structure/definition/contour

drooping neck/thin skin

Why are you considering Aesthetic treatments now?

special occasion (wedding, reunion, milestone birthday, engagement, baptism etc.)

increased video calls

major life event

I feel like I look older than I am

people say I look more tired when I am not

I want to enhance an area that I never had volume to begin with

Thank you for visiting us!

First name

What injectable sevices interest you? * Required

Botox

Dermal Filler

PRP

PDO threads

CO2 skin resurfacing

Skin boosters

Nurse training

Do you want us to email you about those services?

yes

Last name

Phone

What aesthetic sevices interest you?

Laser hair removal

IPL/Lumecca

Vaginal rejuvenation

Chemical peels

Hydrafacial MD

Exosomes with microneedling

Thank you for choosing us! We truly value your feedback as it helps us improve our services. Kindly take a few minutes to complete this survey, and let us know how you enjoyed our services.

What service did you do today? * Required

injectables

aesthetics

Who was your service provider? * Required

Aida

Katarina

Daniela

how would you rate the overall quality of servces provided by us?

excellent

very good

good

fair

poor

Did the service provided meet your expectations?

excellent

very good

good

fair

poor

How likely are you to recommend Bloom Society services to friends or family?

extremely likely

likely

neutral

somewhat likely

very unlikely

How was our customer service?

excellent

very good

good

fair

poor

Would you like to share any additional comments, suggestions, or compliments?

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