Therapist:_____________________
Date:____________
Client: ________________________
Your evaluation is assessed by the therapist and use as a teaching tool.
Circle all that apply
Quality: Soothing Firm Hesitant Other_______________
Depth: Too Deep Too Light Just Right Other_______________
Pace: Rhythmic Too Fast Too Slow Other_______________
I would receive a massage from this therapist again._______
I would not receive a massage from this therapist again, because:
__________________________________________________________________________________________________________________________________________________
_________________________________________________________________________
Please comment on any anxiety or discomfort about your treatment.
__________________________________________________________________________________________________________________________________________________
________________________________________________________________________
What did enjoy most about your treatment?__________________________________________________________________________________________________________________________________________________
_________________________________________________________________________
What could have made your treatment better for you?__________________________________________________________________________________________________________________________________________________
_________________________________________________________________________
Additional comments and suggestions: __________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
________________________________________________________________________
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