Full Name* First Last Email Address* What is the preferred day of the week and time for your participation?*Saturday (AM) ESTSaturday (PM) ESTSunday (AM) ESTSunday (PM) ESTOtherWhat is the preferred length of the seminar?*1/4 day (2 hours)1/2 day (3 hours)All Day (6 hours)OtherWhere are you most likely to look for health workshops?*FacebookTwitterSpecific Doctor WebsitesGoogleOtherWhat is a fair and reasonable price point?*$25 - $50$50 - $75$75 - $100OtherMore Detail About How You Found Us:*If you chose referral by friend or doctor, please provide the referrer's name here. Thank you.Please list any specific body pains that you would like to see covered in future workshops.*Please also include any additional feedback that you believe would be beneficial for planning purposes.*Any other comments, or notes about questions listed above?*Can we reach out to you about your answers or for additional feedback?* Yes No Terms* I agree I understand that by clicking "Send", I am providing Dr. Blatman / blatmanhealthandwellness.com with the personal information that I filled out above. Dr. Blatman / blatmanhealthandwellness.com will not share or sell this information with anyone outside of our organization, but it may be viewed by our extended team. Thus, do not share confidential or sensitive personal or medical information. By pressing “Send” I confirm and give permission to process my personal data.Security
