Rodney Street Therapies New Year Resolution Questionnaire 2016

www.rodneystreettherapies.co.uk

Your details

Question Title

* 1. What is your last name?

Question Title

* 2. What is your first name?

Question Title

* 3. What is your email address?

Question Title

* 4. How many new year resolutions will you make in 2016?

Question Title

* 5. What are your new year resolutions for 2016?

1.

2.

3.

4.

Question Title

* 6. Which of the following approaches have you taken (or will you take)?

Set SMART Targets

Timetabling new behaviour

Using a counsellor, hypnotherapist or life coach

Other (please specify)

Question Title

* 7. Is it OK to contact you later in the year to find out how you are getting on?.

Yes

No

Question Title

* 8. Is it OK to contact you about offers and events at Rodney Street Therapies?

Yes, please.

No thanks.

Thank you for completing this questionnaire. Wishing you well in your resolutions,

Dennis Richards
Director, Rodney Street Therapies.