Virtual Participant

Name *

First Name

Last Name

Today's Date

MM

DD

YYYY

Phone Number

(###)

###

####

DOB

MM

DD

YYYY

Date of the session you were involved with:

MM

DD

YYYY

How would you rate your virtual experience?

5 meaning you felt like you were in the room with everyone!

1

2

3

4

5

Have you ever taken a class like this before?

Yes

No

Should We Connect With Them?

Yes

No

How would you rate this H.E.A.L. session overall?

5 being "I can't wait for next month!"

1

2

3

4

5