Lemuria Spa - Free Trial Form

Enter your information and we will contact you shortly to schedule your with INTRODUCTORY TRIAL session. We are so excited that you are going to take the first step on this life-changing journey to healthier slimmer you.
Are you interested in Lemuria’s program to?	Lose Weight Lose Inches Detoxify Increase your energy
Why is losing inches & weight important to you?	I want to look better professionally I want to look better for my significant other I want to look better for myself All of the above
Are you interested the Lemuria’s treatments to reduce cellulite?	Yes No
What are your inch loss goals with Lemuria’s treatments?	Minimal Toning Lose Inches from specific areas Lose a dress size Lose two dress sizes
What are your weight loss goals with Lemuria?	I am at my ideal weight now I would like to lose 5 to 10 pounds I would like to lose 10 to 20 pounds I would like to lose 20 to 30 pounds I would like to lose 30 to 40 pounds I would like to lose 40 to 50 pounds I would like to lose more than 50 pounds
Why is losing weight and or inches important to you?	I want to look better professionally I want to look better for my significant other I want to look better for myself All of the above
Are you planning on doing the Lemuria Body Program?	Yes No Maybe
If you answered no (or maybe), what is the main thing holding you back?	I am skeptical Investment Cost
Are you considering plastic surgery, (tummy tuck, liposuction surgery)?	Yes No
What is your exercise activity level?	Sedentary Moderate Very Active Athlete
What brought you to Lemuria Spa?	Radio Ad Magazine Friend (If so, please enter their name:) Post card Search Engine Newspaper
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Lemuria Health Beauty Fitness Spa Inc. will never sell, barter or rent your email address to any unauthorized third party. Thank you for entering your information and we will contact you shortly to schedule your TRIAL session. You can also call us at 949 336 7722 . We are located at 4100 Campus Drive #230 Newport Beach, California 92660 - Cilck here for a Map and Address.