Clinic Evaluation Form

Clinic Evaluation Form

Clinic Evaluation Form

    Student Therapist:
    Date:
    Client Name:
    Client Email:

    To Our Clinic Clients:
    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?