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 12345
Appearance 12345
Courtesy 12345

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