First Trial Form – W Women Wellness

Name

Phone Number

Preferred Appointment Date:

For same-day appointments, please contact our customer service team directly via WhatsApp 017-465 7616 .

Preferred Time Slot:

Once your appointment is confirmed, we will send you a confirmation via WhatsApp.

Select Your Service

Ovary Therapy - 90 mins (RM199)

Breast Therapy - 150 mins (RM199)

Hip & Leg Lymphatic Drainage Therapy - 90 mins (RM199)

Back & Shoulder Therapy - 90 mins (RM199)

Vulva Reshaping - 20 mins (RM199)

IntimaLase Vaginal Tightening - 20 mins (RM399)

LaseFrost Hair Removal - (RM8 - RM198)

Total Amount

Before booking, please review and confirm the following:

We do not recommend undergoing these treatments during your menstrual period.
If you are currently pregnant or suspect you may be pregnant, we advise postponing your treatment.

If you meet the conditions for treatment, please answer the following questions to help us serve you better:

1. Have you had any surgery in the past six months?

Yes

Please provide basic information and dates of relevant surgeries.

2. Do you have any diseases, tumors or gynecological problems? Please include any conditions related to your uterus, ovaries and breasts.

Yes

Please describe the relevant information in detail.

Payment Options

Pay In Store

We prioritise the confidentiality of your personal and health information. All data provided will be used solely for appointment scheduling and treatment purposes.

Please Note: Our team will get in touch within 24 hours to confirm your booking. Your appointment will only be confirmed once we’ve contacted you. If you don’t hear from us within 24 hours, feel free to reach out via WhatsApp — we’re happy to assist!

If you are human, leave this field blank.