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Would you like to make a statement?

Your experiences matter to us! Thank you for taking the time to reach out to The Baccara Institute to tell your story. Please take your time answering the below questions about your experience. If you have further questions please contact us.

Where did this experience take place?

What time did this happen?

Please explain in as much detail as possible what was experienced?

Has this experience continue after the event mentioned above?

Has this experience continue after the event mentioned above?
A
B
C
D
E

If you selected other above, please explain

On a scale of 1 to 5 how has this effected your daily life

On a scale of 1 to 5 how has this effected your daily life
Not VeryVery Much

Check any activities below that have been effected by this experience

Check any activities below that have been effected by this experience

If you selected other above, please list activity

On a scale of 1 to 5 how afraid were you during this experience?

On a scale of 1 to 5 how afraid were you during this experience?
Not VeryVery Much

If further questions are needed how can we contact you? (Optional)

Please only input the information you are comfortable sharing. We do not guarantee that somebody from The Baccara Institute will reach out.

How would you rate your experience with The Baccara Institute? (Optional)

1 Star "I am unhappy with The Baccara Institute." 5 Stars "I love The Baccara Institute, no notes."
How would you rate your experience with The Baccara Institute? (Optional)

Do you have any other feedback for us? (Optional)