Testimonial for Chiron Energy Medicine

First Name: _________________________________________________ Last Name:__________________________________________________ City: ________________________ State/Province: _____________________ Country: _______________ Occupation: _____________________________________________________ In case we need to contact you about your testimonial. E-mail: _________________________________________________________ Telephone Number: __________________________________ Name of your Practitioner (Who is this testimonial for?): _____________________________________________________ Is this testimonial about: O You O Your Partner O Your Pet/Horse O Your Business O Your Performance O Other Family Member (who): _______________________________________________________ O Other (please specify): ____________________________________________________________ Was the session or sessions: O In person O At a distance For your testimonial, please write in your own words and in full sentences in the space below. Here are some helpful tips and ideas to help you formulate and write your testimonial.

What conditions/complaints did you have addressed? What was your life like due with these conditions? How did your performance improve? What happened when you had an Energy Medicine balancing session? How did your condition, symptom and/or quality of life improve? What was your experience of the session? What did you like about the session? How did your animal respond to the session?

Please use the back of the form if you run out of space. Permission to use your name for the testimonial supplied. O Yes, full name. You may use my full name with my testimonial. O Yes, initials. You may use my initials with my testimonial. O Yes, you can use my picture, which is included O You may use my occupation, and location with my testimonial. O Please do not use my name or my initials with my testimonial. If selecting this option your testimonial will not include your name or initials. Permission about how to use this testimonial. O This testimonial may be used by my practitioner. O This testimonial may be used to tell others about Chiron Energy Medicine Thank you for your feedback and testimonial!

Carolyn Osborn, Performance Mentor

CAP, CBP, PaRama BP