Mentorship Program Form

Name

First

Last

Date:

Phone

Email

Hours of Training

Years of Experience

School(s) Attended:

Current Employer(s):

What are your strengths as a Massage Therapist?

What would you like to improve?

What are your career goals?

What type of feedback, if any, are you seeking in techniques?

What type of feedback, if any, are you seeking in quality of touch?

What type of feedback, if any, are you seeking in any other area?

Experience

Swedish

Sports

Pregnancy

Deep Tissue

Trigger Point

Myofascial Release

Neuromuscular Therapy

Acupressure

Reflexology

Structural Bodywork

Ashiatsu

Thai

Craniosacral Therapy

Zero Balancing

Lymphatic Drainage

Other: list below and rate to the right