Survey Test

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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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