Client Post-Massage Assessment Form

Client Post-Massage Assessment Form
In this form are the details of your massage session with themassagenegotiator.com mobile massage therapy services. The Massage Negotiator: (951) 358-9116, themassagenegotiator.com
Client Full Name
First NameLast Name
Your massage therapist this visit:
First NameLast Name
Massage Therapist email
example@example.com
Client email address
example@example.com
Date of Massage session
MonthDayYear
Time of Massage Session
:HourMinutesAM/PM Option
Duration of Massage Session
minutes
Your pain on a scale of 1 to 10 with 1 being the least pain and 10 being the worst pain before the session was:

1 2 3 4 5 6 7 8 9 10
1 is Least Pain, 10 is Worst Pain
Your sleep scaled on a 1 to 10 with 1 being the least amount of sleep and 10 being more than enough sleep in the week before this massage session was:

1 2 3 4 5 6 7 8 9 10
1 is Least Sleep, 10 is Most Sleep
Your stress for this week was scaled on a 1 to 10 before this massage session, with 1 being the least stressed and 10 being the most stressed, as:

1 2 3 4 5 6 7 8 9 10
1 is Least Stressed, 10 is Most Stressed
Before this massage session the primary focus of the massage was listed as:
Before the massage the pressure, modalities, and flow of massage was requested to consist of:
This is how your massage session negotiated the pain and stress away from your body:
The areas below on the selected human figure were worked on or need more work. Some abbreviations: 'DT'-deep tissue, 'x'-avoid, shade/circle-more focus, 'MF'-myofascial, 'ESM'-erector spinae muscles, ROM-stretch/range of motion, '+' for more work, '-' for less work, Lt-light pressure, Med-medium pressure, frm-firm pressure, Tk-client ticklish, Pn-client has pain, adh-adhesions/knots, Tns-tension/tight/taught muscle groups and fascia.
The following are some suggestions for your next massage session by your massage negotiator.
Pain negotiation was met with massage techniques involving varying pressure, modalities, and tools that can change from massage session to the next to maintain a pain and stress free body.
You can also negotiate the pain in your body away from causing you harm by scheduling your next massage in 2-4 weeks, staying hydrated, stretching often, not sitting or standing too long, and getting enough sleep.
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Thank you so much for using themassagenegotiator.com for your mobile massage therapy needs.
Massage Therapist Signature
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