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Feedback Form

As my valued Client, I'm requesting your help. I’ve recently moved and am starting up my business in Pittsburgh, PA. I'm requesting your feedback and would like to post your responses to the below questionnaire on my website. Thanks, I appreciate your help!

Client’s name: Male Female
Street Address:
City, State, Zip
Phone Number:
Session by:
Type of Service:
Referred by:
Date of service:
Email address:

INTUITIVE READING FEEDBACK:

1. May I use your full name and state of residence when posting your reference?

2. If not your full name, may I use your first name, last initial and state of residence?

3. At times, specials will be run on intuitive services. Would you like to be placed on Annie's newsletter mailing list?

4. How many readings has Annie performed for you (please estimate if unsure)?

 5. Was the reading helpful to you? Please comment.

6. What impacted you the most about the reading? Please comment.

7. Would you consult with Annie again regarding future issues?

8. Do you have any suggestions to help Annie improve her services?

 
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