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Transforming with Jasmine

Client testimonial form

Headshot (please attach to email and tick agree if so - unless using video testimonial):

Rating your therapy and/or coaching program:

On a scale of 1 to 5, how would you rate my services?

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Your testimonial statement

(please type hereafter - or summarize key points if you have provided a video testimonial):

You can base your testimonial on the following questions:

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Upload youvideo testimonial

Authorization and release information:

I understand that “my testimonial” provided above and made on behalf of Yasmina Nagnoug Mejai may be used in connection with publicizing and promoting herself and/or her brands and/or her company. I authorize Yasmina Nagnoug Mejai to use my name, (headshot), brief biographical information, and the Testimonial as defined on this form.

I hereby irrevocably authorize Yasmina Nagnoug Mejai to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing her programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites, or in any other distribution media.

I agree that I will make no monetary or other claims against Yasmina Nagnoug Mejai for the use of my Testimonial statement.

In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my likeness or my testimonial appears.

I hereby hold harmless and release Yasmina Nagnoug Mejai from all claims, demands, and cause of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I have read the authorization and release information and I give my consent for the use of my testimonial as indicated above,

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