Patient Check-Out
Appointment Details:
- Body Cavitation
- Laser Lipolysis
- EMSculpt
- Pressotherapy
- LED Light Therapy
- Deep Cleansing Facial
- Neck Treatment
- Vampire Facial
- Microneedling
- Chemical Peel
- Neurotoxins
- Dermal Fillers
- Filler Dissolvers
- IM Shots
- IV Drip
- Platelet-Rich Plasma / Platelet-Rich Fibrin
- Kybella / Fat Dissolver
- Hair Restoration (Non-injectable)
- Exosome Rejuvenation Therapy
- Fat Dissolver Injections
- Consultation
- Other
- No elements found. Consider changing the search query.
- List is empty.
- Abdomen – Upper
- Abdomen – Lower
- Ankles
- Arms – Upper
- Arms – Lower
- Bra Line – Front
- Bra Line – Back
- Back – Upper
- Back – Mid
- Back – Lower
- Bikini Line – Standard
- Bikini – Extended
- Brazilian – Full
- Buttocks – Upper
- Buttocks – Lower
- Calves
- Chest
- Feet / Toes
- Hands
- Hips
- Knees
- Thighs – Inner
- Thighs – Outer
- Thighs – Back
- Thighs – Front
- Underarms / Axilla
- Waist / Sides (Flanks / Love Handles)
- Face – Full
- Face – Lower (Perioral / Jawline)
- Face – Cheeks
- Face – Sideburns
- Upper Lip
- Chin
- Jawline / Beard Area
- Neck – Front
- Neck – Back
- Nape / Hairline
- Full Body
- Other (Specify in Notes)
- No elements found. Consider changing the search query.
- List is empty.
- Upper Face – Horizontal Lines
- Upper Face – Between Brows (Frown Lines / “11s”)
- Upper Face – Eyebrow Lift
- Upper Face – Crow’s Feet (Sides of Eyes)
- Upper Face – Bunny Lines (Sides of Nose)
- Mid / Lower Face – Nasolabial Area (Smile Fold Support)
- Mid / Lower Face – Gummy Smile
- Mid / Lower Face – Lip Lines (Smoker Lines)
- Mid / Lower Face – Lip Flip (Upper Lip)
- Mid / Lower Face – Corners of Mouth (Downturned Corners)
- Mid / Lower Face – Chin (Dimples / Orange Peel)
- Mid / Lower Face – Jawline Slimming / Masseter
- Neck & Lower – Neck Bands (Platysmal Bands)
- Neck & Lower – Necklace Lines (Horizontal Neck Lines)
- Neck & Lower – Décolletage (Chest Lines)
- Functional / Other – TMJ / Jaw Tension (Masseter)
- Functional / Other – Migraine / Headache Treatment
- Functional / Other – Excessive Sweating – Underarms
- Functional / Other – Excessive Sweating – Hands
- Functional / Other – Excessive Sweating – Feet
- Functional / Other – Other (Specify in Notes)
- No elements found. Consider changing the search query.
- List is empty.
- Balance due payment (settling prior balance)
- Service - Injectable
- Service - Non-injectable
- Add-on - Non-injectable
- Add-on - Injectable
- Retail product - Skincare
- Retail product - Other non-prescription
- Tip only
- No elements found. Consider changing the search query.
- List is empty.
- Cash
- Card
- Cherry (Payment Plan)
- PatientFi (Payment Plan)
- Affirm (Payment Plan)
- Check
- Wire Transfer
- Reward Points
- Other
- None
- No elements found. Consider changing the search query.
- List is empty.
For Patient Only:
Service Completion Acknowledgment
I, the undersigned client, confirm that I received the above service(s) in full from Dr. Lift Spa on the date indicated.
I acknowledge and agree that:
The treatment/service was completed to my satisfaction, and I have no outstanding concerns at this time.
I authorize Dr. Lift Spa to charge my payment method on file for the amount due for this completed, one-time, non-recurring transaction.
All deposits and payments are non-refundable once services are rendered, in accordance with Dr. Lift Spa’s Terms & Conditions (drliftspa.com/terms-conditions).
Any future treatments or add-on services will require separate authorization and payment.
I release Dr. Lift Spa and its staff from any further claims or disputes related to the service performed, except in cases of gross negligence or willful misconduct.
For Provider Use Only:
- Gia
- Belinda
- Jasmin
- Alan
- Eden
- No elements found. Consider changing the search query.
- List is empty.
- Pending Outcome Resolution
- Paid For Promo Only
- Completed a Single Session
- Purchased one more session
- Purchased product(s)
- No-Sale - Showed, but didn't receive service
- Consultation Only
- Incomplete Session - Need to Reschedule
- Subscribed to Membership
- Purchased a Package
- No elements found. Consider changing the search query.
- List is empty.