Review of your VelaShape™ Procedure

Please take a moment to share your procedure experience in this brief survey.


*Indicates required field

*First Name:

*Last Name:

Email:

*City:

State:

Doctor/Clinic:

Other Doctor:

*Please Rate Your Overall Satisfaction with this Procedure (10 being the best)

1
10

*How much did you pay for this procedure (before extra fees, taxes):$

*Describe your procedure experience below (Please review the procedure only, NOT the provider):


(doctor/provider reviews can be filled out separately, on SignatureForum's practice pages; feel free to access these upon completion of this survey)

I give my permission to use this VelaShape™ review on SignatureForum
(Your first name, last initial and city will appear with this review)

Yes
No

I'd like my review to remain anonymous:

Yes
No