BEFORE THE TREATMENT

1. Where did you receive your massage: Health club___ Chiropractic office___ Hospital___ Salon___ Private
Practice___ At your home___ At their home___ Hotel___ Massage School___ or other______________________?
2. What was the therapist full name (the name of the therapist will not be shared with anybody in the class)
___________________
3. Did you: Call for an appointment____ Have someone else make the appointment for you___ or walk in to make an appointment?
4. What was the price of a 1-hour massage:
less that $30__ $30__ $35__ $40__ $45__ $50__ $55__ $60__ $65__ $70__ more than $70__
5. If you called for an appointment, did they explain whom it is with: yes___ no___ did not call___?
6. If you called, did the person on the phone explain to come early to fill out a health form: yes___ no___ did not call___?
7. Was your therapist a: male_____ female_____?
8. If you called for an appointment were the directions, they gave you: easy to find___ hard to find___ knew were it was before___?
9. Ask how long have they been practicing_______________?
10. Ask where they went to school for massage training _________?
11. What city did you receive your massage in ________________?
12. Did the therapist introduce herself or himself to you: yes__ no__?
13. Did the therapist say your name when you arrived: yes__ no__?
14. Did the therapist seem nervous: yes__ no__?
15. Did the therapist seem professional: yes__ no__?
16. Did you fill out a health form: yes__ no__?
17. Did the therapist go over the health form with you and ask questions: a lot__ little__ no__?
18. Do you think there could have been more questions on the health form: yes___ no___?
19. Was there a question on the health if you wear contacts or glasses: yes__ no__?
20. Did your massage start: on time___, late___ little earlier___?
21. What kind of environment was the massage clinic: relaxing_____ stressful______ average_____?
22. Was the place clean: yes___ no___?
23. Did the therapist explain what a full-body massage entails: yes__ just a little__ no__?
24. Did the therapist explain how they drape: yes___ no___?
25. Did the therapist use: sheets___ towels___ sheet and blanket____ to drape you?
26. Did the massage table feel like there was extra padding on the table: yes___ no___?
27. Did the therapist ask if you needed to use the restroom before the massage: yes__ no__ went on your own__?
28. Did the therapist call the massage table a: bed_____ table_____?
29. Did the therapist explain to get under the sheets: yes___ no__?
30. Did the therapist give you an option if you wanted to start supine or prone: yes__ no__?
31. Did the therapist tell you were to put your clothes and jewelry: yes__ no__?
32. How far did the therapist tell you to dress down to: underwear__ what you feel comfortable with___ or did not explain___?
33. Did the therapist knock or ask to come in before he/she entered: yes__ no__?
34. Did the therapist wear shoes: yes__ no__ and what kind______?
35. Did the therapist ask if you are allergic to anything: yes__ no__ on the health form__?
36. Was the therapist friendly: yes__ no__?
37. If the therapist had long hair: long hair down__ long hair up__ short hair__?
38. Was the therapist nails cut: yes__ no__?
39. The music was: too loud__ or soft__ just right__ no music at all__?
40. Did the therapist have you read a “client bill of rights”: yes__ no__?
41. Did you sign a “Client’s Bill of Rights” (C.A.M. LAW): yes__ no__?
42. Did the therapist offer stomach massage: yes__ no__?
43. Did the therapist offer breast massage: yes__ no__?
44. Did the therapist offer glute massage: yes__ no__?
45. Did the therapist ask if he/she could massage your scalp: yes__ no__?
46. What did the sheets smell like: oil___ clean___ Perfume___?
47. Was the therapist’s sleeves: short___ long___ or long and not rolled up___?
48. Could you see any other client’s files lying around: yes__ no___?
49. Did the therapist have any cuts or open areas on their hands or forearms: yes__ no__?
50. Did the therapist have any jewelry on their hands or wrists: yes__ no__?
51. Look to see if they have liability insurance anywhere visible: yes__ no__?
52. Look to see if they have their diploma anywhere visible: yes__ no__?
53. Was there oil stains on the walls or carpet: yes___ no___?
54. Did the sheets on the table look stained: yes___ no___?
55. Was there a clock in the massage room: yes___, no___?
56. Did the therapist have pictures of their family: yes___ no___?
57. Did the therapist have a name tag: yes___ no___?
58. Was the therapist’s shirt: tucked in___ or out___?

DURING THE TREATMENT

1. Did the therapist ever go under the sheet: yes___ no___?
2. Was the headrest adjustable: yes___ no___?
3. Was the table wide enough: yes____ no____?
4. Did the therapist offer you a bolster: yes___ no___?
5. Did the therapist adjust or take out the bolster before you turned: yes___ no___?
6. Did the massage table have an armrest: yes___ no___?
7. Did the therapist go into detail about their personal life: yes___ no___?
8. Did the therapist ever talk about sex, religion, race or any other things that are inappropriate: yes___ no___ if yes explain_____________________________________________?
9. Did the therapist work on only the areas that they said they would work on: yes___ no___?
10. Did the therapist have the oil bottle: under the table___ on the table___ on a shelf___ or in a holster___?
11. Could you hear the therapist breathing: yes___ no___?
12. Was the therapist quiet when you did not want to speak: yes___ most of the time___ no___?
13. Could you feel the therapist’s nails: yes___ no___?
14. Were the therapist’s hands cold to start: yes___ no___?
15. Did the therapist breath smell: yes___ no___?
16. Did the therapist have body odor: yes___ no___?
17. Were there any scents in the massage room: yes___ no___?
18. Did the therapist have any perfume on: yes___ no___?
19. Did the therapist have gum or candy in their mouth: yes___ no___?
20. Was the massage table heated: yes___ no___?
21. Did the therapist ever go to your feet to your face without washing their hands: yes___ no___ started with the face___?
22. Did the therapist use: oil___ massage lotion___ on your body?
23. If you wore underwear, did the therapist tuck the sheet into your underwear:
before asking____ did not ask____ did not tuck them in____ did not wear underwear____?
24. Did you hear any change in the therapist’s pockets while you were receiving your massage: yes___ no__?
25. Did you hear other people or sounds while you were getting a massage: no____ little____ a lot____?
26. Was the massage room: really dark_____ some light_____ or a lot of light_____?
27. Could you feel a draft when the therapist was draping you: yes___ no___?
28. Could you feel the therapist breath when the therapist was draping you: yes___ no___?
29. Did you feel comfortable with the way the therapist draped you: yes___ no___?
30. How much of the quads and hamstrings were exposed: ½___ ¾___ or all___?
31. Was the room: too cold___ or too hot__?
32. Did the therapist ask you at any time if the room temperature was comfortable: yes___ no___?
33. Did the therapist check in with you about the amount of pressure given: yes___ no___?
34. Did the therapist keep contact with you almost all the time and did they leave body contact to get oil or go to the other side of your body: yes___ no___?
35. Was the massage a full-hour from the time they laid their hands on you, to the time they took them off you: more than___ less than___ one hour___?
36. Did the therapist ask you if you wanted to relax after the massage and how long: yes___ no___?
37. If you have tattoos, did the therapist comment on them: yes___ no___ did not have tattoos___?
38. If you have moles, did the therapist mention anything about them: yes____ no____ did not have any____?
39. If you have scars, did the therapist mention anything about them: yes____ no____ did not have any____?
40. Did the therapist warm the area up before they started to go deeper: yes___ no___?
41. Did the therapist use scented oils without checking with you first: yes___ no___?
42. When the therapist worked on your upper chest: yes___ no___?
43. Did the therapist work your glutes: with the sheet on__ partly draped__ sheet totally off__ or did not even work them__?
44. Did the therapist use: oil___ lotion___ or nothing___ on your face?
45. Did the therapist say anything about energy work: yes__ no__?
46. Did the therapist do any energy work without asking: yes___ no___?
47. Did the therapist ever get on their knees: a lot___ little___ or never___?
48. Did the therapist ever sit on the table: a lot___ little___ or never___?
49. Did the therapist ever sit in a chair: a lot___ little___ or never___?
50. Did the therapist use each strokes at least 3 times: most of the time__ some of the time__ hardly ever__?
51. Could you feel their shirt or any other part of their body: yes___ no___?
52. Was the therapist using proper body mechanics when you were supine: most of the time__ or not much__?
53. Did the therapist ever tell you, to let them know if the pressure was too light or too deep: yes___ no___?
54. Was there a rhythmic flow with the massage: most of the time___ not much___ never___?
55. Could you recognize any strokes they were using: a lot___ some___ hardly any___?
56. Did you think the therapist used: too much oil___ or too little oil___?
57. Did the therapist ever name any muscles during the massage: yes___ no___?

AFTER THE TREATMENT

1. Did the therapist give you a glass of water after the massage: yes___ no___?
2. Did the therapist tell you to drink a lot of water after the massage: yes___ no___?
3. Did the therapist recommend anything for you to do after the massage: yes___ no___ if yes then what___________________?
4. Did the therapist ask you to schedule another appointment: yes___ no___?
5. Did the therapist explain to come back on a regular basis (ex. 1X week/ 4 weeks = evaluation): yes__ no__?
6. Did the therapist diagnosis anything: yes___ no___ if yes then what_________________?
7. Did you tip the therapist: nothing__ $1-$5__$6-$10__, more than $10__?
8. Did the therapist try to sell you anything: yes___ no___?
9. Did the therapist answer any questions you had: yes___ no____?
10. How long were you there, from the time you walked in the door to the time you left: 1 hour__ 1:15__ 1:30__?
11. Would you ever get a massage from that therapist again: yes___ no___?
12. Would you recommend other people to go to that therapist: yes___ no___?
13. Did the therapist give you a business card before you left: yes___ no___?
14. Did the therapist wipe off the excess oil when your massage was done: yes___ no___?
15. Was there a mirror to fix your hair in the massage room: yes__ no__?
16. Did the therapist meet you right after the massage: yes___ no__?
17. Did the therapist offer any: cold packs__ or hot packs__ nothing__?
18. Did the therapist tell you to get up slow after the massage: yes___ no___?
19. Did the therapist explain that you might have side effects after the massage: yes__ no__?