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Let's keep in touch!
* First Name : 
* Last Name : 
Address 1 : 
Address 2 : 
City : 
State : 
Zip : 
* Phone : 
* Email Address : 
 
 
 
We offer classes on how to energize, heal, and detox your body. Please check all the options below that apply to you.
 
Yes, I would be interested in attending a class
 
Yes, I would be interested on a one on one session
 
Yes, I would like to host a class

 
 
How satisfied are you with the following:
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied
Energy levels
Eating habits
Emotional state
 
 
 
Are you currently using natural and/or organic options in your daily routine?
 
Yes
 
No
 
 
 
Would you like to subscribe to my upcoming newsletter about health & wellness?
 
Yes
 
No
 
 
This week how many times did you?
1 time 2 times 3 times 4 times 5 times 6 times
Meditate
Sleep 7+ hours
Physical activity
Stretch
Eat your veggies
Skip a meal
Nurture yourself
Take your vitamins
 
 
 
It was an honor meeting you today! Please leave any comments or questions that come to you now.
   
 
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