The Virility Center The Virility Center
....................................
....................................
....................................

The Anti-Aging and
Vitality Center of Cleveland

Felicitas Juguilon, MD
Medical Director
Chief Medical Officer, AVC
Board Certified Anti-Aging
6000 Lombardo Center Dr. Suite 150
Seven Hills, Ohio 44131
(Tel) 216.573.5600

....................................

The Anti-Aging and
Vitality Center of Atlanta

Michelle M. Fischer, MD
Medical Director
Board Certified Anti-Aging Medicine
325 Hammond Drive
Suite 204
Sandy Springs, GA 30328
(Tel) 404-255-5583

Alise Jones-Bailey, MD
Board Certified Anti-Aging Medicine
Board Certified OB-GYN
325 Hammond Drive
Suite 204
Sandy Springs, GA 30328
(Tel) 404-255-5583

....................................

The Anti-Aging and
Vitality Center of Dallas

Nancy Wiese, DO
Board Certified Preventive Medicine
Member Institute Functional Medicine
6101 Chapel Hill Blvd.
Suite 200
Plano, TX
(Tel) 972-312-8881

Juan Francisco Quiroz, MD
Board Certified
Family Practice Medicine
Member American Academy of
Anti-Aging and Regenerative Medicine
6101 Chapel Hill Blvd.
Suite 200
Plano, TX 75093
(Tel) 972-312-8881

....................................

The Anti-Aging and
Vitality Center of Pittsburgh

Aldino L. Pierotti, III, MD
Medical Director
Board Eligible
Anti-Aging Medicine
Member American Academy
of Anti-Aging Medicine
201 South Craig Street
Suite 100
Pittsburgh, PA 15213
(Tel) 412-235-7087

....................................

Corporate Office

Anti-Aging & Vitality Centers
7570 West 147th Street
Suite 302
Saint Paul, MN 55124
(Tel) 800-599-7820

     
         

 

  Lipo Selection Survey    
   
 
       
   
Question 1: Do you have high blood pressure? Yes No
Question 2: Do you have diabetes? Yes No
Question 3: Do you have any chronic illness?. Yes No
Question 4: What is your Body Mass Index (BMI)?
(Please enter the computed BMI result from calculator above)
    
Question 5: Do you smoke? Yes No
Question 6: Do you occasionally purge or binge? Yes No
Question 7: Do you diet often? Yes No   
Question 8: Is your weight stable? Yes No 
Question 9: Do you exercise regularly? Yes No
Question 10: Do you have a history of unrepaired hernias? Yes No
Question 11: Have you had any abdominal surgeries? Yes No
     
Name:    
Phone Number*:    
E-mail Address*:      ex. name@domain.com
Zip Code*:    
Age*:      Sex*:  
   
     

"Take our survey to qualify for $50 off during
   your first COMPREHENSIVE VISIT with us."

We value your privacy.  Under no circumstances will we
give any of your personal information to third parties
 


 

 
     
     
     
     
     
     
     
       
       
       
       
       
       
       
       
       
       
       
       
       
     

 

 

 

 

   
         

Our Core Beliefs | About Us | Our Staff | Locations | Recommended Links| Contact Us | Testimonials

 

All material on this website is protected by copyright, Copyright © 2006-2009 by Anti-Aging & Vitality Centers, Inc.
Website Created by Discovery Towers Website Design