Dr. Bart's Cleanse Kit Reservation
Balance Health Studio is thrilled to host Dr. Bart's Cleanse! Please complete the form below in order to reserve your Cleanse Kit for January 2018.
Email address *
First and last name *
Your answer
Phone number *
Your answer
Have you participated in Dr. Bart's Cleanse in the past? *
What cleanse duration would you like? *
Do you prefer a Dairy-Free option? *
What is your preferred flavor for your shake powder? *
Do you plan to attend Dr. Bart's LIVE Cleanse talk at Balance Health Studio, Tuesday, January 2 at 5:30pm? *
To guarantee your Cleanse kit availability, we require pre-payment. Would you like to prepay? *
When would you like to pick up your Cleanse kit from Balance Health Studio? *
Is there anything else you'd like us to know?
Your answer
Looking forward!
A copy of your responses will be emailed to the address you provided.
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