Online Registration

Senara offers our intake form online for new CoolSculpting guests. Available as a downloadable PDF, you may fill out your intake form at your convenience before your first visit with us.

If you have not scheduled your initial consultation appointment yet, please call 309.285.8979 prior to filling out the form.

Senara CoolSculpting Guest Printable Form

To download and print your intake form, please follow these steps:

  • If AdobeReader® is not yet installed on your computer, download it first.
  • Using AdobeReader or AdobeAcrobat, you can download forms, print them out and fill-in the required information.
  • Click the link below to download the form:

When you finish completing your form, you may bring it with your appointment, send it to us via Email, or, you can print and send your forms to us at this mailing address if your appointment is a week or more away.

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