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141 E. High Street Pottstown, PA 19464
(610) 705 - 4401

Clinic Evaluation Form

    Student Therapist: Date:
    Client Name:
    Client Email:

    To Clinic Client:
    We encourage you to provide feedback about your student massage directly to your therapist but, we would appreciate you taking a moment to fill out this evaluation form. This evaluation will assist the Academy of Massage Therapy & Bodyworks in continuing to educate our students and promote professionalism in the massage therapy field. Thank you for your participation in our student clinic.

    1) Have you ever received massage therapy prior to this session? YesNo
    If YES, what type (Deep tissue, Swedish)? When

    2) Did your massage therapist make you feel comfortable? Were you given enough information about the massage (sequence, pressure)? YesNoSomewhat
    Comments:

    3) Was your massage environment comfortable? Ex: temperature, lighting, noise, etc.
    YesNoSomewhat
    Comments:

    4) Were your instructions about disrobing and draping complete enough to allow you to feel comfortable?
    YesNoSomewhat
    Comments:

    5) Did you feel that your therapist was professional in acknowledging your medical conditions?
    YesNoSomewhat
    Comments:

    6) Did you feel your primary areas of pain or discomfort were focused on during your session?
    YesNoSomewhat

    7) Do you feel that the pressure and fluidity was adequate throughout the massage?
    YesNoSomewhat
    Comments:

    8) Did your massage flow smoothly from one body part to another?
    YesNoSomewhat
    Comments:

    9) Were your questions and concerns answered confidently and professionally?
    YesNoSomewhat
    Comments:

    10) What areas do you feel were your therapist’s strengths?

    11) Do you feel your therapists had any specific weaknesses?

    12) What comments do you have, if any, to help make them a better therapist?

    13) How would you rate your therapist? 1= Low 5=High

    Professionalism
    Appearance
    Courtesy

    14) Do you have any additional thoughts or comments on how we can improve our student’s clinic?

    Request More Info

    Request More Info

    We know life gets busy making it hard to visit us for a tour or open house. We’re always available to answer your questions and happy to help. Please fill out the form below and our admissions staff will email you information and follow up with you to answer any questions you may have.

      By submitting this form, you are giving your consent for our admissions staff to reach you at the phone number you have provided.