From Active Image

Forms: Preliminary Client Information 2

HEALTHY BY DESIGN WORKBOOK

Name: Required
Your email: Required
Address:
Address 2:
City:
Province:
Postal Code:
Daytime Telephone:
Evening Telephone:
  
What is your age?
What is your current weight?
What is your desired weight?

Feedback from workbook

My three points impacted you the most?
On a scale of 1 being poor and 10 being great,how would you rate the introduction:
On a scale of 1 being poor and 10 being great,how would you rate the content of the topics:
On a scale of 1 being poor and 10 being great,how would you rate the biblical stories:
On a scale of 1 being poor and 10 being great,how would you rate the scriptures:
On a scale of 1 being poor and 10 being great,how would you rate the daily declarations:
Would you recommend it to other? ( yes or no) (staate their names)
Do you feel this program will help you reach your goals?
How much would you pay for this workbook?
Did you complete the daily exercises? If not, why not. If yes, did you find them helpful
What other suggestions/recommendations could you offer?

Thank you so much for your feedback.
As a special thank you for participating, you will receive a complimentary of the workbook and a hard-cop of the complete book in the spring.

Cathy Morenzie

Please be sure all areas are completed before pressing 'Submit'. Incomplete forms will produce an error and entries will be lost. Hint: Answers can be typed in a word processing program or notepad first, then pasted into the form.
 
 
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Page last modified on December 14, 2010, at 02:38 PM