Therapist Evaluation

We would like to thank you for assisting our MFR therapists in taking advantage of this Myofascial Release experience. Please be as honest as you can with as much constructive criticism you can offer. We will discuss your comments with our MFR therapists so they can learn and improve with your guidance.

Client Name *

First

Last

Date and Time of Session *

Date

Time

Therapist Name *

• Trevor
• Eric
• Tana
• Kelley

Therapist’s ability to address your complaints and goals: *

Therapist’s ability to explain MFR, fascia and unwinding before, during and/or after your session: *

Therapist’s ability to help you feel safe and supported during any unwinding movements: *

Therapist’s ability to communicate throughout the session and dialog when needed to help you release: *

Therapist’s ability to be comfortable with silence and keep their personal sharing to a minimum: *

Therapist’s ability to stay present and hold restricted areas long enough to release (meaning they did not rush or force through something you wished to be held longer): *

Therapist’s ability to explain after session care and homework: *

Therapist’s ability to follow up regarding upcoming appointments: *

Therapist’s continued support to update homework as needed (for additional appointments only):

Therapist’s ability to remain grounded, connected to your fascia and keeping their own intentions out of the session (for therapist's responses only):

Therapist’s ability to properly execute basic MFR techniques such as arm pulls, leg pulls and cross-hand releases (for therapist's responses only):

Any extra comments you would like to share:

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