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12363 W. Colonial Drive
Winter Garden, FL 34787


386-DR-TOWER

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Scholarship Application

Applicant Information

Birthday
Month
Day
Year

Section A: Weight Loss Applicants

Date of Bariatric Surgery, if applicable
Month
Day
Year
Do you have any more pregnancies planned?
Yes
No
Are you currently using GLP-1 medication (Ozempic, Wegovy, etc.)?
Yes
No
Current Smoker?
Yes
No
Can you have surgery in the next 6 months?
Yes
No

Section B: Body Areas of Concern

Select all that apply

Section C: Upload Recent Photos (Front, Back, & Side)

Upload full body photographs, per the following instructions:

  • Please take photos in front of a plain background. 

  • Photos should be taken from just below your chin to your knees. The whole torso area should be visible.

  • Keep your arms in natural position at your sides.

  • Take photos without any garments on; for example, no shirts covering the abdomen area (may wear bikini top or bra- optional); underwear covering just the pubic area is acceptable.

  • Keep the camera angle straight forward. Do not angle down or up.

Take 3 shots:

  1. Front view shot

  2. Side view shot

  3. Back view shot

Section D: Consents

I understand that photos and videos submitted with my application may be publicly shared as part of the Scholarship selection and promotional process.
Yes
I grant BodyByBeauty permission to use my name, written application, photographs, video content, and personal story in marketing, promotional, educational, and advocacy materials in any media format. I waive the right to inspect or approve final materials
Yes
If selected, I understand that all travel, lodging, and personal expenses related to participating in the Scholarship are my responsibility.
Yes

I understand that cosmetic surgery is a medical procedure with risks and potential complications. If selected, I agree to undergo full medical evaluation, provide medical history records, and complete the informed consent process before surgery. This application does not guarantee medical approval for surgery

Yes

Section E: Soft Credit Check

All applicants must submit a soft credit check through Patient Fi by following these steps:

  1. Go to www.PatientFi.com 

  2. Click on “For Patients”

  3. Click on “Apply Now”

  4. Enter Zip Code 34787

  5. Enter Body by Beauty in “Practice”

  6. Click “Search”

  7. Click “Apply”

I understand the requirement of a soft credit check and will complete alongside my application.
Yes

Section F: Terms and Conditions of Agreement

I have read and fully agree to the Terms & Conditions of the BodyByBeauty Surgery  Scholarship. I certify that the information I have provided is true and complete.

Yes

Section G: Signature and Submission

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

By submitting this application, you confirm that all information provided is accurate and agree to the terms of the Scholarship.

Date
Month
Day
Year
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