Preliminary Client Information 2

Daily Inspirational Quote:

"We are what we repeatedly do,
excellence then is not an act,
but a habit."

Aristotle

Active Image
261 Oakwood Ave.
York, Ontario
M6E 2V3
Tel: (647)883-5436
cathy [snail] activeimage [period] ca -> mailto:cathy [snail] activeimage [period] ca

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HEALTHY BY DESIGN WORKBOOK

Name:	Required
Your email:	Required
Address:
Address 2:
City:
Province:
Postal Code:
Daytime Telephone:
Evening Telephone:

What is your age?
What is your current weight?
What is your desired weight?

Feedback from workbook

My three points impacted you the most?
On a scale of 1 being poor and 10 being great,how would you rate the introduction:
On a scale of 1 being poor and 10 being great,how would you rate the content of the topics:
On a scale of 1 being poor and 10 being great,how would you rate the biblical stories:
On a scale of 1 being poor and 10 being great,how would you rate the scriptures:
On a scale of 1 being poor and 10 being great,how would you rate the daily declarations:
Would you recommend it to other? ( yes or no) (staate their names)
Do you feel this program will help you reach your goals?
How much would you pay for this workbook?
Did you complete the daily exercises? If not, why not. If yes, did you find them helpful
What other suggestions/recommendations could you offer?

Thank you so much for your feedback.
As a special thank you for participating, you will receive a complimentary of the workbook and a hard-cop of the complete book in the spring.

Cathy Morenzie

Please be sure *all areas are completed* before pressing 'Submit'. Incomplete forms will produce an error and entries will be lost. Hint: Answers can be typed in a word processing program or notepad first, then pasted into the form.

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The information contained within ActiveImage.ca is for educational purposes. It is here to help you made informed decisions about your fitness and health. It is not medical advice and is not intended to replace the advice or attention of health-care professionals. Please consult your doctor before beginning or making changes to your diet, exercise program, for diagnosis and treatment of illness and injuries, and for advice regarding medications and supplements.

In no way will Active Image or any persons associated with Active Image be held responsible for any injuries or problems that may occur due to the use of this website or the advice contained within. Active Image will not be held responsible for the conduct of any companies and websites recommended within this site.