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Emsculpt Neo Patient Survey

Discover if you’re a candidate for Emsculpt Neo to achieve your health, strength, andmobility goals.

Please fill out the survey below so we can tailor the right treatment for you!

Birthday
Month
Day
Year
What are Your primary goals? Check all that apply

Lifestyle and Wellness

How often do you engage in physical activity?
How would you describe your eating habits?
Are you currently experiencing any of the following?

Strength and balance

Have you experienced any of the following?
Are you looking to improve balance and coordination in daily activities or exercise?
Yes
No

Treatment Area Preferences

Which areas of your body are you most interested in strengthening? (Check all that apply)

Motivation and Expectations

How committed are you to achieving your goals?
Very committed
Somewhat committed
Unsure
How quickly are you looking to see results?
Within the next month
1–3 months
3+ months
Would you like to combine treatments (e.g., fat reduction and muscle strengthening) for optimal results?
Yes
No
Are you interested in learning more about Emsculpt Neo’s solutions for your goals?
Yes
No

Investment Readiness

How much are you willing to invest per month to achieve your goals?
Less than $250/month
$250–$500/month
$500+/month
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