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Massage Therapy Feedback Form

25%
Date/Age Group
Date
Age Group
Your Experience
Please tell us more about your massage experience by rating each question on a scale of 1 to 5, where 1 = Poor / No, 3 = Good / Possibly and 5 = Excellent / Absolutely.
How did you feel BEFORE your massage today?
How did you feel AFTER your massage today?
How beneficial did you find your massage today?
Do you believe other families would benefit from this service?
How do you rate your overall experience from today?
Your Health
Did the massage help with any of the following? (please tick any that are relevant to you)
Consent
From time-to-time data collected is used for research and clinical statistical purposes. Do you consent to your Feedback which is de-identified being used for oncology massage research purposes?
If yes, please sign.
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