WALL of PHLEXcellence Sign Up / Testimonial Submission

Name

First Name

Last Name

Email Address

Therapists Name

Favorite Sports/Acitivities

Anything active you love to do, list them all!

Most inspired by?

Can be someone famous, friend, family or submit a quote that you live by.

Awards, Accomplishments, Milestones?

No answer is too big or too small! From running your first race, to losing weight, to not having pain during activity, to winning a game...we want to share your story!

How has your experience at PHLEX improved your life?

Did our Therapists help you achieve a milestone? Are you now pain free? What would you tell a friend about your experience?

Overall Rating of Experience:

Excellent

Good

Fair

Please elaborate on your Rating of Experience.

We want to make sure your entire experience is top notch!

RELEASE STATEMENT: I authorize PHLEX NYC to use the above testimonial on their web site or in any other form of advertising that they see fit. I authorize the use of my full name in connection with the use of this testimonial in any manner PHLEX NYC determines is appropriate. This is including but not limited to their web site, advertising, mailers, etc.

Please check YES and send your photo to VIP@phlexnyc.com.

YES