What brings you to Regenerix Tick everything that applies — most people tick two or three.
Face — lines, volume, lifting, skin quality Skin — texture, pigmentation, acne scars, glow Body — contouring, localized fat, skin tightening Hair — thinning or loss Energy, immunity, recovery, healthy ageing Joint pain or a sports injury Weight — medical weight management Women's intimate health Men's intimate and performance health Surgery — face or body I'm not sure — I'd like Dr. Sibaja to advise me
Tell us a little more — what would you like to change or improve, and what have you tried so far?
When are you thinking of coming? As soon as possible Within 1 month 1–3 months 3–6 months Just exploring for now
Comfortable budget for treatment (optional — it helps us suggest the right options) Under $1,000 $1,000 – $3,000 $3,000 – $7,500 Over $7,500 Not sure yet
Health basics So Dr. Sibaja can prepare. Not a full medical history — she takes that in person.
Any medical conditions we should know about? · optional
Are you pregnant or breastfeeding? No Yes Not applicable
Do you take blood thinners (aspirin, warfarin, etc.)? No Yes Not sure
Do you smoke or vape? No Yes Occasionally
May we ask you for photos of the area by WhatsApp before your consultation? Yes No
Previous surgeries or procedures on the face or body (optional)