The form was made in the application
Online tool for creating forms

Your name and contact information is not published nor do we share it in any way, shape, or form. It is simply required for your feedback authenticity verification. Only your testimonial may be published on our website and you can choose how to sign your testimonial.

Contact details

Feedback form




Phone Number:

Email address:

What treatment or service did you receive at DS Holistics?

Was DS Holistics treatment / session helpful?

Treatment / session helped to a great extent

Treatment / session was useful to some extent

Treatment / session was not  helpful

Would you recommend our clinic and services to your friends and colleagues?

If you have any suggestions or comments to improve our service please let us know here:

We would appreciate a testimonial from you to include on our website. If you would like to leave a testimonial please add it here:


You may use abbreviations, maiden name or a fake name and a different living area if you wish. You may also use your real name.

Today's date:


Living area: