Doctor's Survey

Congratulations in permitting us to assist you in receiving a clearer understanding regarding your personal HEALTH. We have assisted thousands of individuals in looking and feeling better with the Longevity for Life Herbal Cleanse Program.

Assist the Doctor by answering some simple questions and he will give you a special Gift of Health!

You will immediately receive your FREE BodyBestTM  CD ($29.95 value).

If you're already a patient or have previously purchased products, do NOT complete this survey as you already have ALL of the available materials.

Honestly answer the following questions and then press the submit button at the bottom:

 

  1. Are you interested in doing the Longevity for Life Natural Herbal Cleanse Program to improve your health?

     

    2. Yes
     
    No

     

  2. What is your number ONE health complaint or concern?

    If you selected Other, please provide more information here:

     

  3. What brought you to DrRossDC.com?

     

    4. Banner
     
    Search Engine
     
    Postcard
     
    Magazine Advertisement
     
    Friend's Recommendation
     
    Other:
     

     

  4. If you used a Search Engine, What subject or keywords did you use when you found our site?:

     

    5.  

  5. If you did not finish reading our detailed introduction to the program, what kept you from finishing it?

     

    6.  

  6. Are you planning on purchasing the Longevity for Life Natural Herbal Cleanse Program to Improve Your  Health?

     

    7. Yes
     
    No
     
    Maybe
     

     

  7. If your answer is no (or maybe), what is the reason your holding back?

     

    8. Thank you for assisting the Doctor. To receive your FREE Gift of Health the BodyBestTM CD. Please list your name and address below.

     

    First Name:
    Last Name:
    Address:
    City:
    State or Province:
    Zip/Postal Code:
    Country:
    Email Address:

    Yes, send me "Life Line" the latest Hot News from the Life Center for Health each month.

 

We honor your privacy and freedom to privacy. We will NEVER share your email address.

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