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Therapist Client Referral Feedback Questionnaire

For My Pamper Party to continue its services and provide extra income opportunities for therapists, personal fitness trainers and course/workshop teachers a small percentage of earnings will become due from individual practitioners by donation after the assignment is completed. This works on an honor system and I agree to complete a feedback form including details of therapy / services and monies earned from the given assignment within 48 hours.

Please complete the Therapist Client Referral Feedback Questionnaire form in full. Thanks...

* Required fields
Name *
E-mail Address *
Contact Tel: *
Address line 1 *
Address line 2 *
Town / City *
Post Code/ Zip *
County/State/Province *
Country *
Name of Client *
Please Copy & Paste Into This box The Client Enquiry Referral Details Sent To You By Email *
Type of Booking *
Booking Date: (DD/MM/YY) *
Treatment Details: Please List Individual Name of Clients, Treatment Given, Length of Treatment & Cost *
Did you complete a Contra-Indications form for each Client * Yes
No
Did you ask & receive written Treatment Feedback from the Client/s * Yes
No
Please declare total amount earned from the assignment *
Did you work with other Therapists on the assignment * Yes
No
Please give Therapist/s Name, Email Address & Contact Tel: (if no please type N/A) *
Are the Therapists that worked with you Registered with My Pamper Party * Yes
No
N/A
Would you Recommend My Pamper Party to other Therapists? * Yes
No
How can we improve our service to Therapists? *
Would you like to be given the opportunity to work on future assignments? * Yes
No
Your Feedback Comments about My Pamper Party would be most welcome (This may be used in future Therapist Testimonials on our website) *

I have read and agree to the Privacy Policy *

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