SPA Evaluation Form

Todays Date

MonthDayYear

Full Name

First NameLast Name

Age

Birth Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail

Date Of Service

Date

Massage Therapist Name

First NameLast Name

How satisfied were you with your overall experience at our spa?

Did your massage therapist address your areas of concern?

How was the pressure during the massage?

Which reason(s) most closely reflect why you seek massage therapy?

Please evaluate your massage theraphy

SKIN CARE & SPA EVALUATION FORM