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  2. (valid email required)
  3. My business relies heavily on word of mouth. By providing a testimonial, it can be displayed on this website and then other people can also benefit from my services. Any constructive feedback is welcome so patient services can be improved. Your time and thoughtfulness is gratefully appreciated. Please complete and submit this form.
  4. I agree for my: full name/ first name only/ age/ town to be published with my testimonial. (Please tick what you agree with).
  5. How would you rate the service received from Sari’s Natural Medicine? Please circle a number from 0-5, with 1 being poor, and 5 being outstanding.
  6. Authorisation and Release Information: I understand my testimonial as outlined above (the "Testimonial") may be used in connection with publicising and promoting Sari’s Natural Medicine. I authorise Sari’s Natural Medicine to use my first name, brief biographical information, and the Testimonial as defined on this form. I hereby irrevocably authorize Sari’s Natural Medicine to copy, exhibit, publish or distribute the Testimonial for purposes of publicising Sari’s Natural Medicine’s programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against Sari’s Natural Medicine for the use of the statement. I hereby hold harmless and release Sari’s Natural Medicine from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorisation. I have read the authorisation and release information and give my consent for the use as indicated above.

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