Feedback Form (Massage) printable pdf download

(Feedback Form)

Therapist’s Name: ______________________________________

Client’s Name: _________________________________________

Session Length Time: ___________________________

FEEDBACK QUESTIONS

1. How were you feeling before the treatment? ____________________________________________________

2. What did you like most about this session? _____________________________________________________

3. What would you improve? __________________________________________________________________

4. How long was your actual treatment? _____________________________

5. Do you feel that the therapist was knowledgeable? _________________________

6. Did you feel cared for? _______________________________________

7. After having received this treatment, how much better do you feel? _________________________________

PREMASSAGE: Did your therapist…

 Start the appointment on time? ____ Yes ___ No

 Take a current medical history or review your patient intake form with you? ___ Yes ___ No

 Go over procedures, policies and disclosure with you? ___ Yes ___ No

 Discuss your needs and agree on the treatment right for you? ___ Yes ___ No

 Wash their hands before the massage? ___ Yes ___ No

DURING THE MASSAGE: Did the therapist…

 Drape areas of your body that were not being worked on with towels/sheets? ____ Yes ___ No

 Ask you for feedback about pressure being applied? ____ Yes ___ No

 Respond appropriately to your feedback? ____ Yes ___ No

 Answer your questions? ____ Yes ___ No

 Ensure that the room was at a comfortable temperature throughout the session? ____ Yes ___ No

 Have a rhythm or flow? ____ Yes ___ No

POST MASSAGE: Did the therapist…

 Conclude the appointment on time? ____ Yes ___ No

 Provide you with appropriate feedback after the massage? ____ Yes ___ No

PROFESSIONAL ATTITUTE: Did the therapist…

 Dress in an appropriate and professional manner? ____ Yes ___ No

 Allow you to undress/dress in private? ____ Yes ___ No

 Have towels/sheets large enough for secure draping? ____ Yes ___ No

Feedback Form (Massage)