IBJI Health Performance Institute Cancellation Form

Full Name

Email *

Participating Location:

*

Highland Park

Morton Grove

Mount Prospect

Bourbonnais

Other

Service(s) You Wish to Cancel (check all that apply):

*

Adult Group Training (Build)

Athlete Academy

Private Training

Massage Therapy/Acupuncture

Pilates

Other

Reason for Cancellation (check all that apply):

*

Financial reasons

Schedule conflicts

No longer using the service

Moving away

Dissatisfied with the service

Injury/Medical

Temporary break (Interested in returning later)

Other

Feedback & Improvement:

Is there anything we could have done to improve your experience? *

Would you consider returning in the future?

*

Yes, I might return in the future

No, I do not plan to return

Unsure

Other

Would you like to be contacted about rejoining at a later date?

Would you like to be contacted about rejoining at a later date? *

Yes

No

Maybe

I agree to provided by the company. By providing my phone number, I agree to receive text messages from the business.