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Refer a Friend

If there is someone you know who would be interested in receiving  a session from Lotus Way Shiatsu Clinic, please take a moment to fill in the referral form below and your friend will be contacted.

Because word of mouth is so important when it comes to receiving personal bodywork, your recommendation is greatly appreciated.

I want to refer a friend:

Your information:
Full name:
Email address:
Telephone number:
Can we use your name?
Yes
No
Your friend's information:
Full name:
Email address:
Telephone number:
Comments:
 

 
 
 
Lotus Way Shiatsu Clinic
231 N. Grant St., Westmont, IL  and 825A Chicago Ave., Evanston, IL
Phone: (630) 887-7278 email jim@lotusway.net

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