Transform Your Body With Mr. America Jason Kozma

This form is to determine your eligibility for a phone appointment to apply to my VIP Private Coaching Program.  It is very intensive and requires significant investment and is not for everyone.

For those looking for a lesser investment choose the Workout and Nutritional Plans option under the Online Personal Training heading.

“I tell all clients that I am the “last person you will ever pay” for fitness advice again, because it’s true. The goal here is to make a forever plan, because after all, if you are fit for a month or a year, who cares? It’s about LIFE. And about being able to soak up life while being fit.

As such, I am NOT the cheapest, but I will solve your problem for good. You will NOT need me at the end of this program, so consider this a ONE TIME investment. In fact, if you still NEED me, I failed you.

Yes, It’s a long application form. But if you can’t be bothered to spend the time to fill it out it’s an early indicator to us that you’re not a good fit for the program”

  • What is your goal?
    ...Lose 50 Lbs
    ...Tone up
    ...Get to 10% Bodyfat
    ...Be Healthy for my kids
    ...Overcome Anxiety/Depression

  • What have you tried in the past?

  • What stopped you from achieving your goal AND/OR sustaining it?
    Sustainability of the plan...
    Need Accountability...
    Don't Know What To Do...
    Plateaued Then Gave Up...

  • Is your spouse supportive of your health goals?

  • Are you willing to invest financially to reach your goals?
    If you came through a promotional offer, then this would mean other things like buying different food or supplements to support that goal (Yes or No)

  • If accepted, how soon are you looking to get started?
    If you are not ready, please wait and only schedule when you are.
    We expect individuals that are ready to get started.

  • 1) I am a person who keeps my commitments and will show up on time to an appointment, including a phone appointment.
    2) I realize that that Jason is in fact a "real person" with a family, other clients and a life of his own whom also values his time.
    3) I acknowledge that he is not training paid clients in order to speak with or meet me. He is giving his time freely in order to help me, and I will honor his time as he is honoring mine by being on time.

  • 1) I will respond to the text when he reaches out.
    2) I will confirm the appointment via text by responding "yes" or "no" that I will answer / show up.

  • If you are in the LA area, you can be eligible for an in person application appointment in lieu of the phone call. Just say so when you reply to my text to schedule the call.
  • This field is for validation purposes and should be left unchanged.
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