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Spa Sanity's Massage Survey
This form will be used to collect information to help us identify those that may benefit from our Health and Wellness services.
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Name
*
First
Last
Email
*
Email
Confirm Email
Gender
*
Male
Female
Your County Of Resident
*
Wake
Durham
Chatham
Franklin
Lee
Johnston
Granville
Person
Vance
Wayne
Pitt
Lenoir
Other
Do you receive Massage Therapy & Bodywork services
*
Yes
No
How often do you receive Massage Therapy or Bodywork services?
*
Once per week
Bi-Weekly
Once per month
Once every 3 months
Once every 6 months
Once per year
Once every few years
How much do you currently pay for a quality 60 minute Massage session?
*
$40 or Less
Between $40 and $75
Between $75 and $100
$100 and more
How often would you like to receive Massage Therapy or Bodywork services?
*
Once per week
Bi-Weekly
Once per month
Once every 3 months
Once every 6 months
Once per year
Once every few years
What do you feel is a great price for a quality 60 minute custom massage?
*
Between $40 and $75
Between $75 and $100
$100 and more
What is your gender preference for Massage services?
*
Male
Female
No Preference
Would you be willing to drive to Keisler Dr., Cary NC to receive Massage services?
*
Yes
No
Maybe
What days and times work best for you to receive Massage services?
*
Weekdays (Monday-Friday) 10am-5pm
Weekdays (Monday-Friday) 5pm-10pm
Weekends (Friday-Sunday) 10am-5pm
Weekends (Friday-Sunday) 5pm-10pm
Check all that apply.
What actual days and times work for you to receive Massage services?
*
Would you be interested in receiving Massage Therapy at discounted prices?
*
Yes
No
Maybe
Check all services that might interest you!
*
Health Coaching
Massage Therapy
Fitness
Business Solutions
Wellness Education Program
Mobile Massage Therapy
Meal Planning
Self Development Audio Books
Group Accountability Coaching
None
Check all that apply.
May we contact you?
*
Yes
No
Contact Number
*
Best way to contact you?
*
Text Message
Phone Call
Both
For additional comments, questions, or information please text below.
*
Submit