After The Reconnection

After The Reconnection

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

City

Can you describe the experience you had during The Reconnection sessions and in between?

What was the single biggest result or benefit you've noticed since your Personal Reconnection?

What was your life like before The Reconnection?

What were the results you noticed immediately after your Personal Reconnection?

Have you noticed any secondary benefits since your Personal Reconnection?

May I use your testimonial on my website?

	Yes
	No

May I use your first and/or last name (or initial) on my website?

	Yes
	No

Name as you wish it to appear on my website?

May I link your name to your email address so that potential clients can email you and ask you questions about your experience?

	Yes
	No

Other Comments

Please enter the word that you see below.

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