Cellulite Treatment Outcome Survey
Please complete this survey to help us evaluate the outcomes and satisfaction following your cellulite treatment.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Age
*
Gender
*
Female
Male
Non-binary
Prefer not to say
Which area(s) did you receive cellulite treatment for?
*
Thighs
Buttocks
Abdomen
Arms
Other
What type of cellulite treatment did you receive?
*
Please Select
Laser treatment
Radiofrequency
Acoustic wave therapy
Topical creams
Other
When did you receive your most recent cellulite treatment?
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please rate your satisfaction with the results of your cellulite treatment.
*
1
2
3
4
5
Since your treatment, how would you describe the appearance of your cellulite?
*
Significantly improved
Somewhat improved
No change
Worse than before
Please indicate your level of agreement with the following statements regarding your cellulite treatment experience.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The procedure was comfortable
1
2
3
4
5
I received clear instructions before and after treatment
6
7
8
9
10
I would recommend this treatment to others
11
12
13
14
15
Did you experience any side effects after your cellulite treatment?
*
No side effects
Mild redness/swelling
Bruising
Pain/discomfort
Other
Please provide any additional feedback or comments about your cellulite treatment experience.
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