Women's Wellness Cancellation Request Form

As part of our cancellation process we require a written cancellation notice and a few questions to provide us with important feedback that will help us with your cancellation process. Your feedback is so important to us and we want to hear how we can better serve you in the future.

Full Name *

Email *

What membership plan were you participating in? *

How satisfied were you with your services? *

BadGood

How informative was our staff and team of medical professionals? *

Are you aware of our Freeze option? *

What is the reason you are deciding to cancel? *

How likely are you to refer Women's Wellness to your friends? *

Not likely at allVery likely

Do you have any additional feedback you would like to share?

I understand that by cancelling my membership I will no longer have access to additional services within my membership such as complimentary check-ins, consultations or follow up lab work.

I understand that If I were to re-enroll in a membership with Women's Wellness Of Mississippi I would have to go through the initial intake process again *

I understand

We hope that you enjoyed your experience and will come back to see us soon! Thank you so much for visiting us.