Testimonial Form

Full Name: *

First Name Last Name

May we use your name for this testimonial on our website? *

*This helps us build trust with future clients but you have a choice to remain anonymous*

E-mail: *

E-mail is required for you to receive your FREE tincture coupon code.

Phone Number:

Area Code Phone Number

EXAMPLE QUESTIONS:

How has your life changed/improved since your visit with us?

What were your past healthcare experiences like before switching to us?

What stood out the most about us during your appointment?

What surprised you most about our practice?

A minimum of 20 words required to consider your testimonial complete and to receive your FREE Discovering Wellness tincture voucher.

YOUR TESTIMONIAL: *

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Is there anything we could to do improve our patient care and/or your experience?

If you don't have an answer, you can skip this question.

How would you rate our services?: *

ADD A PHOTO OF YOU: (accepts mpg, avi, jpg, jpeg, png, gif)

We will use this photo for use on our testimonial page on our website ONLY. This helps us build trust with our future clients and we would love to see you! :)

Take Photo

Thank you for helping us improve our business! We value your time and that's why we are offering a free tincture in exchange for your testimonial.

Your coupon code will be emailed to you within 48 business hours during our store hours of Mon-Thurs (i.e. if you send in your testimonial on Friday, your coupon code will be e-mailed to you on Monday).

Coupon code is worth $32.99 (typical tincture cost) and does not include shipping but in-store pick-up is available upon request.