Massage Client Survey Thank you for your feedback. Massage students learn best through feedback from their clients. Please be honest and descriptive in your responses. Question Title * 1. When was the session? Date / Time Date Time AM/PM - AM PM Question Title * 2. What was the length of your session? 15 minutes (chair massage) 30 minutes 60 minutes 90 minutes Question Title * 3. How did you feel BEFORE your massage? Not at all Some Moderate A lot Extreme Tension Tension Not at all Tension Some Tension Moderate Tension A lot Tension Extreme Stress Stress Not at all Stress Some Stress Moderate Stress A lot Stress Extreme Pain Pain Not at all Pain Some Pain Moderate Pain A lot Pain Extreme Question Title * 4. How did you feel AFTER your massage? Not at all Some Moderate A lot Extreme Tension Tension Not at all Tension Some Tension Moderate Tension A lot Tension Extreme Stress Stress Not at all Stress Some Stress Moderate Stress A lot Stress Extreme Pain Pain Not at all Pain Some Pain Moderate Pain A lot Pain Extreme Question Title * 5. Did your therapist ask about/address your goals for the session? Yes No Question Title * 6. Do you feel that your goals were achieved with the massage? Yes No Question Title * 7. How would you rate the environment where you received the massage? Definitely aided comfort level Neither aided nor distracted / neutral Caused distraction during the session Equipment used (table, pillows, bolsters, etc.) Equipment used (table, pillows, bolsters, etc.) Definitely aided comfort level Equipment used (table, pillows, bolsters, etc.) Equipment used (table, pillows, bolsters, etc.) Neither aided nor distracted / neutral Equipment used (table, pillows, bolsters, etc.) Equipment used (table, pillows, bolsters, etc.) Caused distraction during the session Draping / covering Draping / covering Definitely aided comfort level Draping / covering Draping / covering Neither aided nor distracted / neutral Draping / covering Draping / covering Caused distraction during the session Temperature of the room Temperature of the room Definitely aided comfort level Temperature of the room Temperature of the room Neither aided nor distracted / neutral Temperature of the room Temperature of the room Caused distraction during the session Music / sound during the session Music / sound during the session Definitely aided comfort level Music / sound during the session Music / sound during the session Neither aided nor distracted / neutral Music / sound during the session Music / sound during the session Caused distraction during the session Lighting Lighting Definitely aided comfort level Lighting Lighting Neither aided nor distracted / neutral Lighting Lighting Caused distraction during the session Aromas / smells Aromas / smells Definitely aided comfort level Aromas / smells Aromas / smells Neither aided nor distracted / neutral Aromas / smells Aromas / smells Caused distraction during the session Question Title * 8. How likely is it that you would recommend this therapist to a friend or colleague? Not at all likely Extremely likely 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 9. Do you have anything to share with the therapist who worked on you? Next