Mentorship Intake Questionnaire for Massage Therapists

Mentorship Intake Questionnaire for Massage Therapists

Help us understand your goals, interests, and experience so we can tailor your mentorship to fit your journey.
Thank you for your interest in the mentorship program. This questionnaire is designed to help me get a clear understanding of your background, goals, learning style, and what you hope to gain from mentorship. Your responses will allow me to tailor our time together so you get the most out of the experience—whether you're looking to refine specific techniques, grow your confidence as a therapist, or take your practice to the next level. Please take your time and answer each question as openly and thoughtfully as you can.
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Personal & Professional Background
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How many years have you been a massage therapist?
What massage school did you graduate from?
What continuing education courses have you taken since graduating?
What inspired you to become a massage therapist?
What kinds of clients do you typically work with?
Do you currently work for yourself, a clinic, or both? (check all that apply)

Self-EmployedClinicOther
What massage modalities are you most comfortable using?

Swedish MassageDeep Tissue MassageTrigger Point TherapyMyofascial ReleaseNeuromuscular TherapySports MassageManual Lymph DrainagePrenatal (Pregnancy) MassageShiatsuThai MassageReflexologyFoot ZoningCraniosacral TherapyCupping TherapyAshiatsuLomi LomiReikiRolfing (Structural Integration)Tui NaHot Stone MassageAromatherapy MassageGua Sha / IASTMOther
What modalities or tools are you currently using in your practice?

CuppingGua ShaIASTMWarm BambooMassage GunTENS UnitOther
Have you ever had a mentor before? If so, what was that experience like?
SECTION 2

Strengths & Weaknesses
What would you say are your greatest strengths as a massage therapist?
What do clients often say they appreciate most about your work?
What aspects of your practice do you feel the least confident in?
Which types of cases or clients feel most challenging to you?
How do you typically handle uncertainty or unfamiliar client presentations?
SECTION 3

Self-Rating & Competency

On a scale from 1–10, how confident are you in the following areas?

Rows	1	2	3	4	5	6	7	8	9	10
Communication with clients
Overall client interaction
Overall presentation and cleanliness
Session planning
Time management
Meeting client expectations
Adapting sessions based on client feedback
Preventing burnout & therapist self-care
Anatomy & muscle function
Muscular assessment
Trigger point therapy
Deep therapeutic work
Light therapeutic work
Using tools like cupping, IASTM, bamboo, or massage guns
Working with chronic pain
Rehab Exercises
Relaxation work
Neck work
Shoulder girdle work
Arm and hand work
Back work
Hip work
Leg work
Foot work
Abdominal work

Are there any skills or techniques you’ve been meaning to learn but haven’t yet?
Do you currently have a client request rate of 70% or more?

YesNo
If you answered No, what do you think is keeping you from reaching this rate? If Yes, what are your strengths that keep people coming back? Is there anything you wish you did better?
SECTION 4

Goals & Vision
What are your short-term professional goals (next 6 months)?
What are your long-term goals (3–5 years)?
What kind of therapist do you want to become?
What would a successful mentorship look like for you?
What do you want to feel more confident doing by the end of this mentorship?
Are there any techniques or modalities you’d like to master or refine?
Are there specific client conditions or populations you want to specialize in?
SECTION 5

Learning Style & Preferences
How do you learn best?

Watching/demonstrationHands-on/doingReading/studyDiscussion/explainingReceiving bodyworkOther
Do you prefer structured lessons or open-ended exploration?

Structured lessonsOpen-ended discussionA blend of bothOther
How do you prefer to receive feedback?
How do you handle constructive criticism?
What kind of accountability works best for you?
How often do you reflect on your work or take notes about sessions?

RegularlyOccasionallyRarelyNever
How do you want to be challenged in this mentorship?
SECTION 6

Logistics & Expectations
Are you considering the Core Mentorship, Advanced Mentorship, or the Elite Mentorship? Or are you looking for A Le Carte training?

Core MentorshipAdvanced MentorshipElite MentorshipA Le Carte TrainingOther
How long are you expecting to continue the mentorship?

3 Months6 MonthsOngoingOtherA Le Carte
Do you want the Embodied Mentorship Add-On?

65 Minute Embodied Add-One95 Minute Embodied Add-OneNo, thank you.
Do you have any limitations or preferences regarding scheduling?
Do you have any current injuries or conditions that might affect hands-on training?
When are you looking to begin the mentorship? What is your current availability? What days/times work best for you?
SECTION 7

Open Reflection
What do you hope to gain on a personal level from this mentorship?
Is there anything you’re nervous or unsure about going into this mentorship?
Are there any questions you have for me as your mentor?
Is there anything else you’d like to share about your background, goals, or intentions?
I appreciate the time and thought you’ve put into completing this form. Mentorship is a collaborative process, and your willingness to reflect on your strengths, challenges, and aspirations is an important part of the journey. Once I’ve reviewed your responses, I’ll follow up with next steps and we’ll look at scheduling our first session. I’m looking forward to working with you and supporting you in your professional growth.
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Mentorship Intake Questionnaire for Massage Therapists

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