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Massage Therapy Services Survey
Pre-Massage
*
Indicates required field
Welcomed you by name
*
Yes
No
Discussed your massage needs and reviewed massage health history form
*
Yes
No
During Massage
Addressed areas noted in consultation
*
Yes
No
Addressed areas found during massage
*
Yes
No
Responded to your comments during massage regarding tenderness or pressure
*
Yes
No
Maintained your privacy
*
Yes
No
Seemed "tuned in" to your needs
*
Yes
No
Demonstrated a caring attitude
*
Yes
No
After Massage
Met with you in a quiet, private area
*
Yes
No
Reviewed findings, stress or problem areas with you
*
Yes
No
Made recommendations regarding massage needs, including frequency
*
Yes
No
Please rate the following: 4=Satifactory 1=Not satisfactory
Comfort during massage
*
1
2
3
4
Pressure of the massage
*
1
2
3
4
Met your goal of the massage
*
1
2
3
4
I would have another massage with this LMT
*
Yes
No
By completing this survey, you are helping up to determine if the therapist meets the EQUIVITA standards and your expectations. Please add any relevant comments below. Thank you for taking the time to give us feedback!
Comment
*
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