We love to hear what you have to say.  Please take a moment and share a little about your experience at A Way of Life Acupuncture.  By taking the time to fill out this brief form, you may be helping someone you do not know decide to try acupuncture.  What a wonderful way to contribute to the health and healing of the world, one person at a time.  Please feel free to use additional space provided.  Thank you for your feedback.

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* 1. What were the conditions that brought you to seek care at A Way of Life Acupuncture?

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* 2. What have your improvements been and how have they contributed to the quality of your life?

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* 3. Would you feel comfortable referring friends and/or family members to A Way of Life Acupuncture?

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* 4. What is your overall level of satisfaction at A Way of Life Acupuncture?

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* 5. May we use your story to encourage other patients?

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* 6. Any other comments or suggestions?

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* 7. I hereby give Christine Yastrzemski, A Way of Life Acupuncture, the right and permission to reproduce, publish, circulate or otherwise use my full name and testimonial. I understand my testimonial may be edited for clarity and/or conciseness.

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* 8. Please type how you would like your name to appear under the testimonial.  (i.e. C Yastrzemski, PVB, Christine Y, PVB)

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