Fill out this questionnaire, print out and bring in to any Total Health System's location and you will receive a complementary 1/2 hour massage as a thank you for your information and time!

You’ve been to Total Health Systems and we hope you’ve seen first-hand how effective a multi-specialty clinic can be! Has your pain been relieved? Has Total Health Systems helped you avoid surgery? How has your Total Health Experience improved your life? Whatever your experience, don’t keep it to yourself! Complete the short questionnaire below. We might just share your story with other patients, the media and/or the Total Health Systems’ website! We love to hear how we have helped improve the health, wellness and quality of life of our patients with the care you have received at Total Health Systems. Your testimonial could help improve the lives of others by showing how Total Health Systems has positively impacted your life.

* 1. What is your name?

* 2. What city are you from?

* 3. What were the circumstances that brought you to us?

* 4. Your impression of our licensed staff:

* 5. What services did you benefit from?

* 6. How has Total Health Systems improved your health and your life? Tell us your success story.

* 7. What would you say to a friend or family member who was curious about Total Health Systems?

* 8. I hereby authorize/do not authorize Total Health Systems to use my testimonial and any information contained herein in its public relations efforts. I understand and approve the disclosure of testimonial information to the media and other individuals and entities that may be involved in the public relations efforts of Total Health Systems. If you answered yes, please bring your printed THS success story to any Total Health Systems location to receive your ½ hour massage as a thank you!

T