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HBMN Programs Survey Form The Hospital-Based Massage Network (HBMN) compiles a list of hospital-based massage programs. The first time a completed survey on a hospital massage program is submitted to Hospital-Based Massage Programs in Review, the program receives a FREE copy of the current edition on CD. Filling out this survey form means that you grant permission to the HBMN to use this information in the HBMN book Hospital-Based Massage Programs in Review. Income figures are used for general statistics only and will remain ANONYMOUS.
The Hospital-Based Massage Programs Survey:
hospital name:
department base:
director of program:
contact person:
program name:
program address:
phone:
fax:
email:
website:
hospital's umbrella corporation:
Is an internship offered?
name, address, phone of massage school associated with internshipl:
Income figures will remain ANONYMOUS
Please state number of practitioners followed by whether they are - RNs / LPNs - PTs - OCTs - CMTs/LMTs - program coordinators - students and interns - other
Please give wage per hour (USD) per practitioner plus hours per week plus whether or not they receive employee benefits.
Please state whether or not these positions are employees, independent contractors or salary.
Does the coordinator occupy another position in the hospital? If so, what position?
Who refers patients for massage" Please give estimated percentage of total referrals from each group:
Do MTs work with: staff ? outpatients ? inpatients ?
Please indicate on which departmentsmassage therapy is offered: OB/Gyn ? oncology ? surgery ? seniors ? infants ? physical therapy ? wellness service ? other ?
Is insurance reimbursement obtained for massage therapy? Are classes are offered? Is research being conducted? Please share any comments or additional information:
