Client Entry Form

First Name *

Last Name *

Address *

City *

Dropdown *

Zip Code *

Email

Instagram (if applicable)

Program *

90 Day Body Transformation

30 Days with J

Is this a renewal? *

Yes

No

Training Start Date *

Weight *

Front *

Maximum upload size: 67.11MB

Rear *

Maximum upload size: 67.11MB

Side *

Maximum upload size: 67.11MB

Meal Plan *

Basic

Vegan

Pescatarian

Gym Access? *

Yes

No

Which Gym? *

If you have any gym equipment, please list: *

Do you experience any discomfort when jumping? *

Yes

No

Please list any food allergies:

Past Injuries:

Current Disabilities:

Please list all current medications, vitamins, and supplements:

Food likes

Food dislikes

How many sessions can you commit to completing each week? *

NOTE: Your answer doesn't automatically determine the amount of sessions you'll be assigned with, this helps with customizing your program.

Extra notes for J Lopez

I've read and accept the 90 Day Transformation Agreement *

Yes