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Describe Your Experience
Please note that all fields followed by an asterisk must be filled in.
How often do you use the workbook?
Everyday
3x a Week
Once a Week
Once Every 2 Weeks
Once a Month
Less than Once a Month
How satisfied are you with the process?
Very Satisfied
Satisfied
Somewhat Satisfied
Dissatisfied
Very Dissatisfied
Describe your experiences since you've been using the workbook.
Any other comments or suggestions?
May we use your testimonial on our website?
Yes
No
If yes, may we use your name on our website?
Yes
No
How would you like your name to appear?
First Name*
Last Name
E-mail Address*

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