JUICE - USATrim - LP

Let’s get started!
What are your weight loss goals? Select all that apply & click NEXT*

Lose stubborn weightFit into smaller clothesTighten up loose skinBoost self-confidenceOther

What areas are you wanting to improve? Select all that apply & click NEXT*

AbdomenGlutes/buttChin/neckBackHips/thighsChest (male)

Has previous surgical work been done on these areas? Select one*

YesNoIt’s complicated!

How many days per week are you physically active/exercising? Select one*

0 Days1 Day2 Days3 Days4 Days5+ Days

On those days, how rigorous is your activity/exercise? Select one*

LightModerateIntense

Are you on any of the following diets? Select one*

KetoVegetarianPaleoVeganOther/None

Any questions about this treatment? Select all that apply & click NEXT*

What will my results look like?How long will it take to see results?What’s the cost?Is there financing available?How many injections will I need?Other

What is your preferred payment method for this treatment? Select one*

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What day would you prefer for your consultation? Select one*

MondayTuesdayWednesdayThursdayFriday

Can we get your name? *
Enter First and Last Name

What’s your best email address?*
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Please verify your cell phone number.*
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