Client Interest Survey
Please answer each question.
Sign in to Google to save your progress. Learn more
Email *
name
email
name of the community where your loved one resides *
Massage offer a wide range of health benefits including improved circulation, pain relief, improved  sleep and improved immune system function. Given these health benefits are you interested in making routine massage part of your loved one's healthy lifestyle, providing the cost is easily affordable?  
Clear selection
Would you prefer to pay for your loved one's massages at the time of appointment (at full market rate) OR billed  to room, included in their monthly rent (at a 30-50% discount) ?
Clear selection
Would you feel more comfortable with a covid vaccinated massage therapist that only works at your loved one's community and no other?  
Clear selection
Would you prefer to schedule these massages with a therapist who comes to the community every week  OR schedule with a therapists who comes to the community sporadically, based on their own availability?  
Clear selection
Would your loved one feel comfortable getting on and off a massage table without assistance?
Both presented and pre-read material
Clear selection
Our Yoga Teachers are specifically trained in leading chair yoga to seniors with cognitive impairment. Participating regularly can improve balance and assist in fall prevention. Given this are you interested in making chair yoga part of your loved one's routine,  providing the cost is easily affordable?  
Clear selection
Would you prefer to have an in-house instructor that only offers classes in your loved one's community and no other?
Clear selection
Would you prefer to pay for chair yoga at the time of the class (at full market rate) OR billed to room,  included in their monthly rent (at a 50-75% discount)  
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of themassageinc.com. Report Abuse