Testimonial Form for Families
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1.
What is your name?
(Required.)
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2.
Where does your loved one reside?
(Required.)
Dosberg Manor
Garden House
Rosa Coplon Living Center
Forest Creek
Meadows
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3.
I consent that my testimonial may be used in Weinberg Campus communication materials including, but not limited to, its website, social media platforms (i.e. Facebook), monthly newsletter, and other communications.
(Required.)
I consent.
I do not consent.
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4.
In using my testimonial, Weinberg Campus may:
(Required.)
Use my first and last name.
Use my first name only.
Not use my name - I would like my testimonial to be anonymous.
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5.
Please offer your testimonial below in the comment box. Note: If a resident's name is included in your testimonial, Weinberg Campus will only use resident first names for publication.
(Required.)
Current Progress,
0 of 5 answered