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Testimonial Request Form

Your feedback is greatly appreciated! If you enjoyed your experience, we would love it if you could share your experience on our facebook page as well (or otherwise). Thank you!
Please provide feedback
Please note that all fields followed by an asterisk must be filled in.
How often do you submit your forms?
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
Somewhat Satisfied
Very Dissatisfied
Has your general attitude (vibration) changed since going through the program?
How has your life changed since starting this process?
What is the biggest result or benefit you've noticed since starting this process?
Do you feel you've created a habit of creating your life as you want it?
Is there anything you'd like to add?
May we use your testimonial on our website?
If yes, may we use your name on our website?
How would you like your name to appear?
May we link your name to your email address so others can contact you to verify your experience?

May we use a photo of you?
If so, please email to

First Name*
Last Name
E-mail Address*

Please enter the word that you see below.


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