Post-Massage Evaluation Form
PERSONAL INFORMATION
You may fill out the evaluation form anonymously, if you wish.
Full Name
First Name
Last Name
Cell Phone
Format: (000) 000-0000.
E-mail
example@example.com
MASSAGE THERAPIST EVALUATION
Date Of Service
-
Month
-
Day
Year
Date
Did your massage therapist address your areas of concern?
*
Yes
No
I did not have areas of concern
Did your therapist effectively communicate before,during, and after the massage?
*
Yes
No
Did you feel safe and comfortable during your massage?
*
Yes
No
Please evaluate your massage:
*
1
2
3
4
5
Please evaluate your massage therapist:
*
1
2
3
4
5
Please evaluate your overall experience:
1
2
3
4
5
We appreciate your feedback! Tell us about your experience:
Do you consent to your feedback being shared, if your therapist chooses to do so? Your personal information will never be shared with anyone, but your testimony is valuable for future customers!
*
Yes, you may share with my first name
Yes, but please keep me anonymous
No, please dont share any of my reported feedback
Signature
Date:
-
Month
-
Day
Year
Date
Send
Send
Should be Empty: