Book Prescriber: Book Prescriber Request Form

Book Prescriber Request Form







Name:




Email Address:




What is your gender?

Male

Female



What year were you born?




Where are you from?




What books make it on to your "all-time" favorites list?




What are the last two books you read? Did you enjoy them?




Which genres do you normally enjoy? (click all that apply)

Action

Biography

Business

Children

Crime

Comedy

Drama

Family

Fantasy

Historical Fiction

History

Mystery

Non-Fiction

Politics

Religion & Spirituality

Romance

Science Fiction

Self-Help

Young Adult



Which genres do you NOT enjoy? (click all that apply)

Action

Biography

Business

Children

Crime

Comedy

Drama

Family

Fantasy

Historical Fiction

History

Mystery

Non-Fiction

Politics

Religion & Spirituality

Romance

Science Fiction

Self-Help

Young Adult



What books, if any, have you disliked the most?




What are your favorite movies?




What are your favorite TV shows?




Which of the following ratings are acceptable to you?

G

PG

PG-13

R



Are you currently in the mood for a particular type of book? (examples: a legal thriller, an easy/beach read, intellectually stimulating, a classic, cheesy romance, something sad or happy, etc.)




Please add any additional information that you would like your Book Prescriber consultant to know.




Would you prefer an ebook recommendation? If so, please specify which format.




Enter Promotion Code or Monthly Membership Code (if applicable)