On a scale of 1-5 with 5 being the best/ideal, how would you rate:

your massage overall? 1  2  3  4  5  

If not 5, how could we improve your massage?

the professionalism and presentation of your therapist? 1  2  3  4  5  

If not 5, how could our therapists improve?

the reception team in regard to helpfulness and professionalism? 1  2  3  4  5  

If not 5, how could our reception team improve?

the overall layout and feel of the clinic? 1  2  3  4  5  

If not 5, how could we improve the clinic?

Name of therapist

Date of visit

How did you find the pressure of your massage?

Did your therapist ask throughout the massage if the pressure was okay? Yes  No  

How did you find the time management of your treatment?

What were 3 things that you felt the therapist did really well?

Therapist praise 1

Therapist praise 2

Therapist praise 3

Did your therapist give you stretches to do at home in between visits? Yes  No  

If so, did this help? Yes  No  

Did your therapist suggest the time frame to come see us again to continue improvement? Yes  No  

Name

Contact number

Email