Feedback Form For Work and Classes With Jenifer Shapiro

1. Please provide the following contact information or leave this blank if you wish to be anonymous:

First/ Last Name
Work Title
City/ State

Is there an office location that you prefer:

Paoli  Malvern  Exton 

Other (please write in your preferences here)

THIS IS THE WORK SESSION, IF YOU WISH ONLY TO OFFER CLASSES INFO, PLEASE SCROLL DOWN. THANKS!

2. What was your original intention for working with Jenifer Shapiro?

3. How would you describe your work with Jenifer?

4. Do you feel you received the guidance, support and other services you wanted?

5. Were there any areas that you feel could be improved or anything that you can offer to improve upon Jenifer's services?

6. How would you describe the changes that have occurred in your thinking, your health and/or your life since working with Jenifer?

7. How would you define Jenifer's services to another person considering working with her?

8. Are there additional services /classes you would like to see offered by Jenifer in the future (ie. more bodywork, workshops, etc.) and are they for any particular area (ie. life's path, building a business, etc.)?  

9. Would you recommend Jenifer's work to others? Please explain why or why not?

10. Would you be interested in attending any of the following classes?(Select any of the following options that apply):

Self-Empowerment  Classes              Holistic Entrepreneur groups                Integrative Yoga and Meditation courses                            

Teen empowerment classes        Shamanic Courses	   Energy Medicine Courses    

Yoga Psychology/ Philosophy Classes            Holistic Nutrition/ Live foods classes     Ongoing Courses

Weekend Holistic Certifications                 Satsangs/ Meditation Circles             Shamanic Drumming Group Sessions   

  Holistic Singles Events              Vision Quest Retreats         NLP/ Hypnotherapy Courses

Please List any other topics of interest here as well as any additional information:

11. In order to provide others with more information regarding the benefits of working with Jenifer and TEC, we may wish to use quotes from this form in TEC literature.  In doing so, we agree to keep your identity confidential in whichever way you prefer (please see examples below).  May we use information from this form while keeping your identity confidential?

Yes
No

12. If we use your information, please tell us how you wish to be referred to (choose all that apply):

First Initial, Last Name, Location (example: J.Shapiro, Valley Forge, Pennsylvania)
First Name, Location (example: Jenifer, Valley Forge, Pennsylvania)
Initials, Location (example: J.S., Valley Forge, Pennsylvania)
Any of the above      No reference, just quote.

 

Thank you for your time.  I look forward to seeing you in soon!