*We’re sorry to see you go and we THANK YOU for your time with us! Please submit the form below to serve as your written cancellation notice. Know that we are always working hard to improve our program and we value your opinion. We appreciate your feedback to help us in the future!

Which PowerStrength Location Do you Currently Belong To? *

Alpine - 919 Alpine Commerce Park NW

Kentwood - 5131 E Paris Ave SE

Jenison - 1308 Rosewood St.

Plainfield - 5246 Plainfield Ave NE

First Name *

Last Name *

Email *

Phone *

Today's Date:

What was your original reason for joining PowerStrength? *

How would you describe your experience at PowerStrength? Did you achieve results or make progress during your time here? *

What is making you want to leave your PowerStrength program? (check all that apply) *

Moving away

Achieved goals and made the progress I wanted

Injury or other personal health issues

Lack of attendance or utilization of program

Schedule - my personal/work schedule changed

Schedule - PSTS session availability/ time-slots offered

Financial situation has changed

Lack of physical results

Consistently dissatisfied with the service received

Family/Personal Reasons

Other (please explain below)

If selected OTHER, tell us what other reason is making you want to leave your PowerStrength program?

What is ONE area your PowerStrength Team could have served you better? *

How likely are you to recommend PowerStrength? *

Would you consider coming back to PowerStrength in the future? *

Yes absolutely!

Maybe, if my concerns are addressed and/or my situation changes

Unsure - Keep me in the loop and stay in touch

No, I’m done.

Any Additional Comments/Questions? *

I understand my cancellation will take effect 30-days from the date this form was submitted and I am able to utilize my membership through the final payment period. I understand that recurring billing will take place as scheduled for the next 30 days and payments are non-refundable. I understand that by submitting this form and adhering to this policy I have successfully fulfilled my membership agreement.