Thanks for taking a few moments to let me know about
your experience with the program.

Program    
How many times did you listen?    
 

What, specifically, did you notice after listening to the program?


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What, specifically, have you experienced?


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What's different?
 
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What challenges have you had?

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How did you learn about this program?
Other comments or questions?
 
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Thank you again for taking a few moments to let me know about
your experience with the program.

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First Name Last Name
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Age    
We often use testimonials from our clients to let other people know how this program may help them. May we use your statements in our promotional material?
If a minor The responsible adult's authorization is required if the response is yes.
Responsible adult's name
Relationship

To your success,

Suzy Grossman

suzyqjaco@hotmail.com