Date of Service

Please enter the date of the service regarding this feedback. If you don't recall the exact date, estimate the approximate date or leave blank.

MM

DD

YYYY

Your Gender *

Male

Female

Prefer not to state

How did you first hear about us? *

Google

Yelp

Search engine (Other)

Ad

Drive-by

Friend

Hotel referral

Don't recall

Other

Overall Satisfaction with your Therapist *

State your overall level of customer satisfaction with your massage therapist on the specific visit for this feedback.

1 (Extremely dissatisfied)

2

3

4 (Neutral)

5

6

7 (Extremely satisfied)

Overall Customer Satisfaction *

Not including your therapist, rate your overall level of customer satisfaction for this visit. Consider factors such as ambience, noise level, front reception, cleanliness, etc.

1 (Extremely dissatisfied)

2

3

4 (Neutral)

5

6

7 (Extremely satisfied)

Based on this experience for which you're providing feedback, would you recommend My Favorite Feet Massage to a friend? *

No

Yes

Name

First Name

Last Name

Phone

(###)

###

####