Feedback Form

Let us know how we can better meet your needs.

Please take a moment to fill out the form & send it to Aquarius.

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How did you learn
about Aquarius?

What kind of organization
do you work for?

Would you like to receive
the Aquarius catalog?

Winter Spring Summer Fall

Would you prefer to receive
email and purchase online?

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We're trying to help you with your future needs - would you like to purchase videos:

In DVD Format:

6 Mos. 1 Yr. Future Never

View video clips online:

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How many videos to you or your organization purchase per year?

The best time of year for my organization to purchase is:

What topics are you interested in?

	Aging / Gerontology		End of Life
	AIDS / HIV, STDs		Family Issues
	Alternative Medicine		Hospice
	Bereavement		Human Condition Series
	Cancer/Oncology		Humor & Healing
	Caregiving		Mental Health / Psychology
	Children's Health		Nursing & Staff Education
	Death & Dying		Relaxation / Stress Reduction
	Disabilities		Human Condition Series
	Disease & Healing / Patient Education		Teen Prevention Issues
	Doctor Is In Series		Women's & Men's Issues

Are there any additional
topics you would like to see?

Additional comments, or
additional feedback you can add
that would help us serve you better.

Contact Information
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I would like to receive email updates and news.