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Mandala Art therapy workshop client interest registration form-Srishti Vataa healing arts & wellness centre
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Email
*
Your email
Name
Your answer
Married status
Single
Married
Divorced
Others:
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Location / Address
Your answer
Age
Column 1
30-35
35-40
40-45
20-30
Column 1
30-35
35-40
40-45
20-30
Are you interested in Mandala Art Therapy online course?
*
Yes
No
Maybe
What will be your expectations from this course?
*
Your answer
Do you have any health challenges or life problems that you are currently dealing with?
*
Your answer
Describe how would your life be different if you didn’t have this problem or situation?
*
Your answer
Any other thing you would like to work on with us?
Your answer
Any other issues or questions?
Your answer
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