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Massage Therapist Evaluation (NWC)
Please mark the following statements with the most appropriate values. These values show the extent to which you believe your assistant has shown their level of dedication.
What is the Full Name of your Assistant?
*
First
Last
(Please enter the first and last name of your assistant, ex. John Smith)
What Campus did your Assistant Attend?
*
Please select
Riverside
Pomona
West Covina
Pasadena
Glendale
N/A
How many Total Days did the Assistant Attend?
*
(Please enter the number of total days attended, ex. 30)
How many Days was your Assistant Absent?
*
(Please enter the number days absent, ex. 2)
How many Days was your Assistant Tardy?
*
(Please enter the number days tardy, ex. 1)
(PLEASE NOTE: A total of 100 hours is required.)
Practical Experience In:
Knowledge of Necessary Stretches
*
Below Average
Average
Above Average
Excellent
Resistance Stretches (PNF or Proprioceptive Neuromuscular Facilitation)
*
Below Average
Average
Above Average
Excellent
Knowledge of the Skeletal System
*
Below Average
Average
Above Average
Excellent
Knowledge of the Muscular System
*
Below Average
Average
Above Average
Excellent
Ability to manage time ALLOWED per treatment
*
Below Average
Average
Above Average
Excellent
Communication (with client regarding problem areas to be worked on)
*
Below Average
Average
Above Average
Excellent
Utilization of Swedish Movements
*
Below Average
Average
Above Average
Excellent
Utilization of Deep Tissue Techniques
*
Below Average
Average
Above Average
Excellent
Positioning Techniques
*
Below Average
Average
Above Average
Excellent
Place of Bolster or other Strain or Counter-Strain Technique
*
Below Average
Average
Above Average
Excellent
Use of Pressure Points
*
Below Average
Average
Above Average
Excellent
Proper Draping Techniques
*
Below Average
Average
Above Average
Excellent
Proper Hygiene
*
Below Average
Average
Above Average
Excellent
Proper Body Mechanics
*
Below Average
Average
Above Average
Excellent
Appointments/Customer Service
*
Below Average
Average
Above Average
Excellent
Computer Knowledge & Skills
*
Below Average
Average
Above Average
Excellent
Personal Traits & Appearance:
Personal Appearance
*
Below Average
Average
Above Average
Excellent
Personality
*
Below Average
Average
Above Average
Excellent
Courtesy & Respect
*
Below Average
Average
Above Average
Excellent
Alertness
*
Below Average
Average
Above Average
Excellent
Cheerfulness
*
Below Average
Average
Above Average
Excellent
Attention to Details
*
Below Average
Average
Above Average
Excellent
Ability to Follow Orders
*
Below Average
Average
Above Average
Excellent
Organizes Work
*
Below Average
Average
Above Average
Excellent
Works Independently
*
Below Average
Average
Above Average
Excellent
Rapport with Patients
*
Below Average
Average
Above Average
Excellent
Sincere Interest in the Massage Field
*
Below Average
Average
Above Average
Excellent
General Comments:
(If you have any other comments please leave them in this box)
Your Name:
*
Prefix
First
Last
Suffix
(Please enter your name, ex. Dr. James Brown)
Your E-Mail Address:
*
(Please enter your e-mail address)
Business Name:
*
(Please enter the business name of the company/hospital you work for, ex. St. Joseph's Hospital)
Your Telephone Number:
*
###
-
###
-
####
(Please enter your telephone number)
