Sample entry form

Sample entry form
Tell us how chiropractic has improved your health and enter to win a (name the prize).
How has your health improved since you have been under chiropractic care?
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(Please use back of form if more space is needed.)

Help us help others. You can help assure our new patients they are in the "right place!" By signing your name below, you are giving us permission to use your quote, first name and last initial, and town in our "Results" book and on our Web site, www.yourwebsite.com.