Over the years I have been to many massage therapists, and also listened to patient feedback on other therapists. There are 15 common mistakes, many of which may be enough to keep patients from returning.

1. Not Being Professional

If you chronically cancel patients, or fail to return phone calls and texts daily, patients will start to look elsewhere. Don't cancel except in the case of a real emergency and return all phone calls and texts before you leave for the day. Patients will not pursue you. If you want to be treated like a health care professional, you need to embody the same professionalism as other health care providers.

2. Interrupting Your Treatment

If you frequently interrupt the treatment, you are more likely to lose the business you already have. You are conveying that your time and business is more important to you than the patient lying on your table. If you don't have a receptionist, either institute online booking or just wait until in between appointments to return calls, and leave a sign in your waiting room asking walk-in's to leave a message.

3. Noise

If your office is in a noisy place like a gym, patients will expect some level of noise. What I am referring to is unusual noises such as a barking dog or children making noise, especially if you have a home-based office. I went to a chiropractor who brought his child into the treatment room with him, which was distracting for both of us. While not all noise is under your control, minimize it as much as possible.

4. Cold Treatment Room

If your patient is cold, they can't relax. It helps to have a heated table pad and blankets, but that may not be enough, because as soon as you expose a patient's body part, they will get chilled. If you turn the heat down overnight, arrive in plenty of time to turn the heat up, or get a timer to turn the heat on earlier so your office is a comfortable temperature by the time your first patient arrives. If you get too hot, wear lighter clothes, but don't try to make yourself comfortable at your patient's expense.

5. Uncomfortable Table

Not having a face cradle, some type of support for the arms, and various bolsters to make the patient as comfortable as possible can be detrimental to your business. If your patient has to keep moving their arms to find comfortable positions or have to tense to hold their arms on table, they can't relax. You need to provide a comfortable face cradle, a place to comfortably place arms in various positions, and bolsters and pillows for underneath ankles, knees, and any other place a patient might require support. Therapists will cite cost as a reason for not investing in comfortable equipment, but it will cost you more in lost business. It is one of the best investments in your business that you can make.

6. Equipment/Office in Poor Condition

Sheets and towels that are torn and stained, equipment that does not work, and a dirty office reflects poorly on your business. Replace worn and stained equipment, and keep your office clean.

7. Too Much Talking

Sometimes, your patient may want to talk and socialize, at other times they may not. The key here is to follow the lead of the patient. Talk when they want to talk (and about what they want to talk about), then fade out when your patient lapses into silence.

8.Not Delivering as Promised/Advertised

If you claim you offer deep tissue massage, you had better be able and willing to deliver deep tissue massage. If you advertise medical massage, you had better know where all the muscles are and how to work on them. I've asked therapists (prior to scheduling) if they knew how to work on specific muscles I needed treated and they said yes, but I left their offices without the muscles being treated, in spite of additional requests during the treatments. It was obvious that the therapists did not know where the muscles were, and hadn't been honest with me when I asked them before I scheduled. If you do not know how to perform the requested service, but claim that you do in order to get the patient in your door, they are going to be disappointed. You should be honest with prospective patients about your abilities and training, which leads to the next point.

9. False Claims of Experience

I've noticed some schools offer 15-hour courses in several modalities, and students graduate thinking they have learned all there is to know about those modalities, and advertise as if they are experts. Fifteen hours will do little more than give you an overview of each modality. You cannot learn to be an expert in Swedish massage, acupressure, trigger point therapy, myofascial release, medical massage, etc., in 15 hours each. If you've advertised that you offer medical massage/trigger points/myofascial release, you need to be able to deliver the goods. If you don't, and patients have a lot of experience with a particular modality, they will recognize your lack of training and you will lose creditability. If you want to advertise that you are an expert in a particular modality, pick one or two and take continuing education classes until you really are an expert.

10. Not Asking Enough Questions

If you are offering any kind of medical massage, you will need to obtain a complete medical history during the initial visit, and an update at the beginning of subsequent visits. Gathering information helps you figure out a starting point for the treatment, allows you to identify the causes and perpetrators of pain and other symptoms, and informs you of what did and did not work during the previous treatment so that you can make adjustments to the current treatment. Also ask questions such as, "Is there anything I can do to make you more comfortable?" And, "Am I missing areas you want worked on?" Be sure to ask if the depth is too hard or too light, and adjust accordingly.

11. Not Listening to the Patient

Perhaps there is a certain body part they don't like or want worked on. Perhaps they don't like to be stretched. Perhaps they have had bad experiences with a therapist working on an area or with a technique that caused them harm in the past. Whether or not you agree with the patient that they should feel that way, that is not your decision to make; you need to respect the wishes of the patient. In any given treatment, you should keep the patient comfortable, and do no harm.

12. Not Doing What the Patient Asks

I'm not talking about anything illegal, unethical, immoral, or contraindicated. If what the patient requests is for some reason contraindicated, then by all means refuse and explain to them why you can't. But you should respect the patient's priorities and preferences and perform the treatment accordingly if at all possible. Often, it comes down to poor time management, which is very common. If your patient asks for a full body massage with a few extra minutes on their aching quads, then don't spend 40 minutes on their upper back and neck (even if you feel it needs it), 10 minutes on the back of their legs, and then be unable to complete the full body massage with the extra time on their quads.  Yes, it is likely true that their upper back and neck may be knotted and need a lot more work, but those are not their priorities, for that particular treatment. You may need to be sure to flip the patient face-up 25 minutes into the treatment so that you have 35 minutes left for the anterior body, including 15 minutes on the quads.

It is the therapist's responsibility to watch the clock and figure out how much time they can spend on each area and still address the patient's priorities. It may be best to treat the priority area first to make sure you spend as much time there as the patient wants, and then divide up the remaining time accordingly, even if it's out-of-sequence from your normal "routine." You may need to give the patient a choice between spending a lot of time on one or two priority areas versus a full-body massage, but whatever the patient decides, you are responsible for managing your time.

13. Not Working on the Entire Muscle

As massage therapists, I'm sure we've all had the experience of having another massage therapist run their fingers up our sore muscle, and they stop just when they are starting to get into something that really needs some work. Learn your muscles, origins and insertions, and consciously think about them with intention as you work on them, and treat the entire muscle.

14. Smelling Bad

I have been to therapists whose feet, armpits, or hands smelled so badly that I had to hold my breath every time they got near my head. Smokers' clothes, hair, and hands can really put off someone who doesn't smoke, and hands can be especially bad when covered in massage oil, even if you have not smoked in the clothes you are wearing.

15. Poor Attitude

Perhaps you haven't had a vacation in a long time and are irritable. Vacation is a tough one in our line of business – we are afraid to take time off when it is slow, and afraid to take time off when we are busy, so we often don't take enough breaks. Since it starts to affect our attitude eventually, it is better to go ahead and take that time off, or your business will suffer anyway. I had one patient tell me she stopped going to a massage therapist because the therapist acted like "the world owed her a living." Your patients do not owe you anything, except payment for a job (hopefully) well done. Acting arrogant and superior also does not sit well with patients.

If you are otherwise a very talented therapist, you may not lose many patients with one or even a few of these "no-no's" (depending on which ones), but several can add up to a poor overall experience. To a point, I'll offer feedback like, "I'm really cold in this room" or "can you please be sure to leave enough time to work on my abdomen this time, or perhaps start face-up today." And if you fix/accommodate those concerns, I'll keep coming to you if I like your technique and attitude. Many patients won't even offer that much feedback; they'll just stop coming and you'll never know why. A patient is unlikely to tell you that you smell bad, that they don't like your attitude, or that you are not professional enough.

If you are looking for feedback on your business practices, trade with other therapists who are more likely to give you broader, honest feedback; it is a good way to gain an understanding of how patients view you and your business. If you are having problems with patient retention, consider that one or more of these mistakes are impacting your business, and make some changes.