It is my intention to provide you with a high-quality experience, based in Spiritual, Loving Energy...one you'll not quickly forget. Optimally, it'll be the "best," perhaps most valuable bodywork experience you've ever had. Your perspectives are valued! "Different strokes please different folks." Hopefully, you'll return soon for another experience. Your clear communication will help me improve your next experience!

Please circle your responses, fill in your name & address, & (optional), a testimonial.

Mail completed form or bring it the next time you come. As a consideration...

1. Over-All Rating	Excellent 7     6     5     4	Poor      3     2     1
2. Opportunity to Describe Your Objectives	Very Clear 7     6     5     4	Vague      3     2     1
3. The Experience	Very Relevant to Me 7     6     5     4	Not Relevant      3     2     1
4. Blending of Styles	Very Adequate 7     6     5     4	Inadequate      3     2     1
5. It Should Prove to Be	Very Beneficial 7     6     5     4	No Benefit      3     2     1
6. Would You Recommend This Work to Others?	Definitely 7     6     5     4	No Way      3     2     1

7. Like additional information? What should I know about anything?
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8. Share a testimonial?
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(Okay to use your name? Yes __ No __)

Name: ______________________________
Address: _____________________________
City, State, Zip: _______________________
Phone: _______________________________