Questionnaire
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Phone:  (304) 345-6800
Fax:  (304) 345-2009
E-mail:  plateorders@bebetter.net
www.bebetter.net

Renaissance Tower, First Floor
109 Capitol Street
Charleston, WV 25301
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1. How often do you use The Portion Plate? 

We would like to know more about you and your Portion Plate Success.
2. What personal goal are you trying to reach and how is the plate helping you? 

3. Can we bring you additional products that may better assist you with your goals?  What products would you like to see?   

4. Would you like to receive emails regarding upcoming Portion Plate products and promotions?

5. If so, please enter your email address below.

6. Please include any additional comments or Portion Plate success stories that you would like to share with us.
Thank you for submitting this information. Our goal is to continue to better our services and products for our customers.

7. Do we have your permission to use your success story on our website? If you agree and we use your story on our site, you will receive a free Portion Plate Kit! Please include your phone # or email above so that we may be able to contact you.

"I am an RN who teaches nutrition to the Department of Mental Retardation population and direct care staff in southeastern Massachusetts. I use your Portion Plate example with EVERY class I teach...it's excellent!"
Candace Miller RN, Fall River Massachusetts
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Multiple times a dayOnce a day4-6 days a week1-3 days a weekNever
YesNo
YesNo