Post-Massage Evaluation Form
PERSONAL INFORMATION
Todays Date
Please select a month
January
February
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Month
Please select a day
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Day
Please select a year
2026
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Year
Full Name
First Name
Last Name
Cell Phone
Format: (000) 000-0000.
E-mail
example@example.com
MASSAGE THERAPIST EVALUATION
Date Of Service
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How satisfied were you with your overall experience at our massage studio?
Very Unsatisfied
1
2
3
4
Very Satisfied
5
1 is Very Unsatisfied, 5 is Very Satisfied
Did your massage therapist address your areas of concern?
Yes
No
How was the pressure during the massage?
Perfect
Too Hard
Too Light
Which reason(s) most closely reflect why you seek massage therapy?
Stress Relief
Pain Management
Injury
Relax & Me-Time
Please evaluate your massage therapy
1
2
3
4
5
The overall atmosphere, cleanliness and quality of the facilities was professional and relaxing?
1
2
3
4
5
Signature
Send
Should be Empty: