Why don’t clients come back?

Getting clients to come back for another session is really the heart of a massage business.  Repeat massage clients are the foundation of a stable massage practice.  So why don’t they come back?

Getting into the heads of people to learn more about this can help you to adjust your work to create more repeat clients.

A recent post in a Facebook group which I posted on my Facebook page (with permission) by a massage therapist inspired my continued research on this.

The top responses were:

  1. The pressure wasn’t deep enough
  2. The therapist creeped me out
  3. The therapist skipped my favorite areas
  4. I never had a massage before
  5. I can’t afford it
  6. It just wasn’t a good massage
  7. The therapist talked to much

Here is my theory on whatever the answer is….

People do not say what they need/want when they are in a relationship where there is a power differential like the massage therapist/client relationship.  People want you to be able to read their mind and just know what they want.  When people are lying half naked, under a sheet and having a stranger touch them, they are vulnerable to begin with so the state of transference is usually magnified.  They want to be cared for and nurtured in a child like way (unknowingly!).   My theory is that some or most all of those answers are also really code for something else.

Communication is key here to work through the issues of transference on the massage table.

The pressure wasn’t deep enough.

Getting the pressure just right is an art form.  It is why people come for massage.  The response from many of the therapists was – well I don’t want to hurt my body or clients don’t really need that deep of work and they don’t know it.

Really?  If a client says they want more pressure, they want more pressure and they won’t come back unless they get it and it feels how they want it to feel.   You can use whatever reason you want, but this is about the pressure and applying the pressure they need and want in order for them to come back.

The therapist creeped me out

Not sure what that is about…too flaky?  Had their halloween mask on still?

The therapist skipped my favorite areas.

I can not tell you the amount of times this has happened to me even.  Even when I tell them something like – I am having left leg pain and they worked the whole session on my back saying that is what they thought I needed.

I can’t afford it.

That really means that they don’t understand what massage can really do for them.  People will pay for what they value.  They will do whatever they have to to get what they want/need.  They will save and skip their morning lattes in order to get massage when they know it is what can help them with whatever thing they are dealing with – some sort of stress or pain that makes their life more challenging.

It may also be code for – the pressure wasn’t deep enough, or you talked to much or any of the other reasons why people don’t come back for massage.

It just wasn’t a good massage.

A good massage – what does that even mean?  A good massage for some is a bad massage for others.  Getting to the clients idea of what constitutes a good massage comes through doing a thorough intake and communicating with the client.  It really is difficult and challenging to say the least especially when people don’t speak up and know that they can and should speak up.  I tell my clients something like – I can feel that there is tension or triggerpoints there but I do not know how it feels to you so you have to tell me.

The therapist talked to much

Oh yes…the gabby massage therapist.  I know I can get caught up in this too.   The focus of your massage session should always and forever be your client. No telling your troubles or complaining about your job.  It is simple but complicated.  How much do you talk in order to get the pressure right and get them the ‘good massage’ that they want in order to get them to come back but yet give them enough information to educate them about what massage really does and what you are doing during a session.  Have an information packed website for starters.  Write about all of the common questions that people ask you, write about how and why massage works.  Here is a list of ideas to keep you going on writing your website content.


Why do your clients not rebook?

See also: Getting clients to rebook

(more than) 100 Reasons to Ditch Your Massage Therapist – by Jill Berkana,  Berkana Institute of Massage Therapy, Denver Massage


The Art of Getting Referrals to Build your Massage Business

Getting clients through building a referral network (aka. word-of-mouth) is really an art form.  Getting this down will mean that your business will basically build itself.

You have to start thinking about who is most likely to refer clients to you for massage.  You have to start thinking about who you actually even want referrals from in the first place. There is nothing worse than getting clients who do not fit your practice philosophy and are more difficult to deal with as far as boundaries and the basic everyday workings of your massage business.  What you want are people who value massage, who respect massage and already understand the value of massage.  You want people who are open to learning about massage and are willing to pay for massage in order to feel better.

The Basics of Getting Referrals

Everyone usually thinks that the process of getting referrals is about going out there and promoting yourself and giving a ‘sales’ pitch to the people you are engaging with.  This is really not true.  When I finally figured this out, it was such a relief.

The biggest thing that needs to be understood when creating a network is that you have to start by making it all about the people you are asking to connect with.

Start with being interested in them First.

Networking is about getting to know other people FIRST to see if you even want to get a referral from them.  Are they most likely to refer people who are your ideal clients?  Will they fit your philosophy of healing and working with clients.

Don’t even take your business cards with you at all to any networking event. That is how serious I am about making it about them first. Everyone who hears that usually says…but I have to hand my cards out at a networking event. That is the purpose of them. It isn’t the purpose of them really. Just handing your card out to random people or people who you know very little about isn’t the best approach if you want to remain focused on getting your ideal client in the door. You first want to know about them so you can decide if you really even want referrals from them.

(Massage referral networking tip – don’t take any cards with you to events but focus on getting other people’s cards and then you can decide when and how you would like to contact them and set up future meetings to get to know them and for them to get to know you.)

Networking is about being curious about people and what they do and what their business is first. That serves two purposes. First you want them to be more open to sending people to you. People will do that when they first feel important or feel heard or appreciated. Secondly, the goal in networking is to find people who have the same values as you do. If they are a health care professional – would you go there yourself or send your mother to them ( if you like your mother that is!)

Referral Streams

There are 4 basic referral streams that you can think about and implement:

  1. Getting referrals from your current clients.
  2. Getting referrals from people you know – your friends, family and people you may do business with
  3. Getting referrals from other medical professionals
  4. Getting referrals from other business professionals

Getting referrals from your current clients is quite simple. Just give the best massage that you can.  Show up on time.  Provide a valuable service and get results.   People will just openly want to refer to you because of that presence.   That way will be a slower way of building your massage business.  They may only tell others when others are in pain or are under stress or are openly asking for a recommendation for massage for whatever reason.   You can take this a step farther and ask them for referrals.  Just openly and professionally tell them that you are building your business and ask something like ” If you know anyone who needs massage for stress or injuries, here is my card – have them call me or email me.  (Be specific with your directions for the referral funnel.)

Giving incentives to give a referral is another method of connecting with current clients although you have to be really careful with incentives which could be seen as a referral fee or kickback.  This applies mainly when you are a health care provider in your state.  You will have to check on the referral fee laws in  your area.  It is often also a very gray area to work with.   Some examples of referral incentives are:

  • Giving a client a $10 off coupon when they refer someone to you
  • Giving a discount to the current client and the client that they refer to you.
  • Giving a client extra time on their massage session when they send someone in to you.

The other thing to watch for with these types of referral incentives is that it is a Privacy issue.  It means that you will have to confirm that the referral actually came in for a massage and tell the person who was referring that they will get the reward.  This may not seem like a big deal, but it is giving away personal health information which is illegal under HIPAA.   Just telling another person that someone had a massage with you is a privacy issue.

The same issues are  a concern if you are getting referrals from your friends, family members or people that you do business with.   So I personally don’t recommend giving incentives for a referral.  It also gets sticky with boundaries too.  There is a risk that people who referred someone will also want special favors like extra time on their sessions or they might want to be excused from being late or missing an appointment.  You have to be really clear about what you are giving and stick to your boundaries.

As far as getting clients to refer other clients to you – that should be a part of your ideal client characteristics. People who like you or I should say love you and your massage will automatically send people to you without having to be given rewards for doing so. They will tell all their friends and co-workers. The one draw back is that as your schedule gets busy make sure you reserve an appointment time for them!

The next step will be to start looking for other health care professionals that you would like to work with. The most obvious are usually chiropractors although they may already have massage therapists working in their office. Even then you could still be a referral source if you have a different type of massage skill or service that is not offered there. Start by going in or calling to ask about their services. Get to know what they are doing and what types of clients that they are working with.

Ask yourself if you want to be working with them too? Would it be a good match for your business model? Do you want to be associated with them? This is one of the most important parts of developing your network. You don’t want to be associated with a chiropractor who is involved in over billing or over treating clients or doing things that you do not agree with as far as treating clients.
Then start looking for local businesses that you would like to work on their employees or people that they work with. What type of business would compliment your business? Who would you like to be working with? Just take a walk in your neighborhood and start looking around for possibilities. Could that Realtor use some gift certificates for people buying homes? Would those offices be interested in getting chair massage done or being part of a research study on massage?


Getting Clients from Medical Professionals

The other way to get referrals is from building a network of other health care professionals that respect your work and will send their patients/clients to you for massage. Some of the people who are most like to refer are:

  • Chiropractors
  • Orthopedic Physicians
  • General Physicians
  • Psychologists/Psychiatrists
  • Acupuncturists
  • Naturopathic Doctors
  • Dentists
  • Physical Therapists
  • Dentists

The key to start getting referrals from others is to refer people to them first or to start a connection with them by emailing, writing a letter or calling their office. Actually the best place to meet doctors and other health care professionals in your area are at workshops, lectures or classes that they might be attending. I also think it is important to first investigate the physician/health care provider to see if you even want to get referrals from them. Do your research.

  • Look at their website.  Does it give you the information you need to make an informed decision about possible care?
  • Would you go to them? Would you send your mother there (if you have a good relationship with your mother?
  • Can you visit them as a client/potential client and interview them to see if they would be a good match?
  • Go in and visit them as a fellow health care provider.  Doctors are used to people stopping in all the time.  You can call to see if they have a scheduled time to take such calls.  Drug salesman and medical supply representatives call on doctors like this all the time so they are used to it.

(I went to a chiropractor early on in my practice for my own health. He ended up sending me clients immediately and he still does today -23 years later.)

I used to work with a chiropractor that had less than ideal billing practices and people were unhappy with their services there. You don’t want to be sending your clients to providers that have issues like that or that also have different ideas about treatment plans for clients than you do. Sometimes it is just a simple matter of educating people about what you do and the things you require. For example: massage is covered by insurance here in WA but only for things that are medically necessary. Stress and anxiety are often not covered and either is maintenance or preventative massage. Many doctors do not know that and refer people for regular maintenance massage. It just takes a few extra steps to start education providers. The best way also is to have a section on your website for doctors/health care providers that you can send people to when you contact them to provide more info.

  1.  Start creating a list of all of the possible connections
  2. Go through this list and figure out who do you think would be the most likely to refer to you and be a good referral source.
  3. Figure out your plan of contacting them.   You can start with letter writing or something easy to just get the process going even though it can be less effective.  The important thing is to be taking steps.
  4. Once you get medical professionals referring people to you, be sure to send people back to their doctors for follow up sessions so they can tell them how much better they are feeling and tell them what the massage has done for them.
  5. You can also follow up with a doctor and send a progress report to give them the recent updates in a clients condition.  Under HIPAA, this is allowed.
  6. When working with doctors, you may be expected to bill insurance for massage services.  There are more and more health insurance companies paying now and in most states you can bill for a Motor Vehicle Collision (MVC) and a work related injury through Workers Compensation or Labor and Industries.   You can see if you want to start learning billing by assessing your cost per client and see if it will help your businesses profits.


How to get massage clients to rebook

Getting Massage Clients to rebook or come in again is the easiest way to build a massage business. Why is rebooking important?  Getting regular clients will create a client base for you to work off of and give you some level of security in your massage business.   You will use less resources trying to get all new clients in the door in addition to having regular income.  The majority of my clients have come in weekly for over 20 years.  A few have come in 2x a week for 20 years.  Just do the math!  A regular repeat client is invaluable to a massage business.

Everyone that lands on your table has the potential to become regular weekly or every other week clients.  Even once a month is a good return rate.  The easiest and most effective thing to do is to just ask.   Ask them when they are leaving your office if they would like the same time next week or tell them what appointment times you do have available and ask if one of these times would work for them.

OK so I guess there is also a lot that goes into getting a client that is ready to rebook that easily.

The first step is to get clients who are open to massage, who understand the value of massage and already want to be regular clients.  You can start that process by determining who your ideal client actually is and create a very targeted marketing campaign towards those people.  One of the best ways to do that is through your website and having an informative website that is filled with many articles on massage, what you do, how massage works and the various conditions that you work with.  Doing this builds trust right off the bat.  People will read it and when they get what you are talking about, they will know that you are the Massage Therapist for them.  I get that all the time from people reading my clinic website that does just that.  Sure I get a lot of people who also do not call for the appointment.  I only want to work on people who already get massage and are open to it.  Just educating them a bit can go a long way.

Once they are in for their appointment, I do an extensive interview.  The interview can go a long way in developing the relationship.  I ask about them and listen.  As I begin to work on them, I repeat their concerns or issues and as I apply massage to different areas, I ask them how the pressure feels and how this specific area feels to get them noticing just what is going on in their bodies.  I show them how it changes with the use of massage by pointing out that it might feel better when I feel the tissue release.  I also point out how other area of the body are affected so when I work on the front of their shoulder/pec area for upper back pain, I explain what I am doing.  Well from all of this you might think that I am talking the whole session but quite the opposite.  I don’t do this with everyone.  I do mainly injury work to begin with.  If you are doing relaxation massage, you can do the same thing by asking about different areas when you start and showing them how it feels when you end.  This is the best way to educated people – showing them how effective massage is.

So by the time I am asking them to rebook their appointment next week, they are already people who are most likely to rebook because they understand the value of massage from learning about me on my website.  There is also the referrals from current clients that does sort of the same for rebooking.  When they are able to really feel the difference in their body, they can also usually see that they need more work!

So then I just ask – When would you like to come in next week?  Do you know your schedule?  Is there a better time of day for you – morning, afternoon, early evening or whatever.  Then I tell them what appointments I have open.

You might need more of a rebooking marketing plan too also follow up with people.  Here are a few things you can try to see what works best for you:

  • Call clients the next day and ask how they feel.  Ask them then if they would like another appointment.
  • Have a new client info kit that has a few articles on the benefits of getting regular massage.  Tell them specifically what they can do to ask more questions or to make another appointment.  Have a brochure or business card with your phone number or booking info on it.
  • Send a postcard or note a day or so after the massage and refer them to an article on your website or write a little summary of their session.  This area seemed tight, but responded well.  This could use more work.  If you got more work…this could help in this way….
  • Send a newsletter either by email or a hard copy to them and add them to your mailing list.  (Your intake form should ask them whether or not they would like to receive a mailing and your mailings should always have a clear way for them to opt out!)
  • Send info on special offers, holiday gift certificate opportunities and self care tips.

Following up with clients is NOT bugging them.  It is just asking for what you need- regular clients to build your business.  Many are grateful for the call or follow up effort if it is done professionally and can be of benefit to them.

Having a follow up program is important if you are using a group buying promotion like Groupon or offering low cost massage to get people in the door.  People who come in for low cost massage in my experience usually only want low cost massage.  They will require more time to educate and get back in the door but it is possible with a good follow up plan.

Are your referrals getting to you?

Getting referrals from clients or other health care professionals can be a big part of building and maintaining a massage business.  Connecting with people and developing a relationship with them is the foundation of a referral network.

Every client you work on has the potential to refer many people to you.  They will go back to their offices exclaiming that they just had a massage or that they finally are getting rid of that nagging back pain.  They will go home to their families exclaiming how good they feel after your great massage.  In most cases people are very willing to refer to you if they like your work and the results they are getting.  In fact that is one quality of an “Ideal Massage Client” that you might want to put on your list.  The first step is just letting clients know that you are looking for clients and would love to have a referral from them.  You don’t even really need to give them incentive for the referral -like offering an extra massage session when they refer so many people.  What you do need is a solid system to get the referral.

When people leave your office and go and talk to their friends and family about their massage they will often say “Why don’t you go for that nagging foot pain you have been having” or “you should try it to help relieve some of that stress”.  So they give people your name and maybe even your phone number but for the most part people are not going to be motivated to call and make the appointment.  It isn’t that they don’t need a massage or trust their friend or whoever is telling them.

People don’t have time.  They don’t have time to figure out if you will work for whatever thing is ailing them.  They don’t know your schedule or if it will work out with theirs.  They don’t know where you are located and it might be too far away taking more time.  They aren’t certain whether or not you will answer the phone and will have time to talk to them.  They don’t know if they leave a message if you will call them back at a time when they will be able to talk.  People procrastinate when it comes to their health until they can’t take it anymore.  That could be months away.  The list goes on and on.

Your website can answer most of these questions and help people feel more comfortable with you.  Your website is where you provide many articles on massage and what you do and build trust with clients.  What people want to know is if you will be able to handle their condition or problem.  With massage that can be many different things- stress, fibromyalgia, foot pain, back pain, neck pain, hip pain, a sport injury, a weekend of too much gardening or hiking, dealing with life at work and at home, grief, anxiety, depression – all of these things and many more of course.  So what do you do?  Yes – Write about them all!   It is just doing the same thing as if they had called and asked you the same questions- Do you work with fibromyalgia?  Have you worked with someone with foot pain?  What do you say on the phone?  What do you say to people when you are working with them on the table and they ask about muscle knots or say ‘is that a knot?’ or my all time favorite is ” Is that a bone? (when you are on a muscle that is so hard that it feels like a bone).

You website will be available 24/7 and should give them all of the answers to any of the questions that they may have.   Once you get them to your website, they still might not be calling but the next best thing is to get them to give you their email and sign up for your email newsletter.  You can also offer them a free report on something like back pain or tips for working on the computer or something like that .  Just giving them incentive to sign up for your newsletter will help them add their email address to your list.

The other missing piece to this could be that there isn’t a clear way for your client to give their friends your name.  I often have people even say – so and so at my office could really use you.  When they do I tell them to send them to my website or call me and I will talk to them on the phone for 20 minutes to see if I can help with their condition.   Tell clients how you would like to receive referrals so that they know what to do!

Action Steps:

  1. Tell client you are building your business and are taking new clients
  2. Tell them how to send referrals to you
  3. Have your website set up with many articles on the things you talk about most with clients and more info on the types of massage you do and what massage does
  4. If you aren’t getting referrals consider setting up a referral system with rewards.  Beware of clients who only come for the rewards or bonuses.

Getting Doctors to Refer to your massage business

Getting doctors to refer clients to your massage business is a big challenge still today even with massage being more accepted and having more research available.  Doctors are usually very busy and don’t have time to learn about something like massage.  There are many doctors and health care providers that would really be helping their patients if they referred more to massage.  Here is a short list of some:

  • Doctors – OBGyn, Orthopedic doctors, Osteopaths, Chiropractors, General practitioners
  • Acupuncturists
  • Physical therapists
  • Dentists

One of first things you want to do though is to actually take the time to find out something about the doctor/provider that you are looking for referrals from.  You may not want everyone to refer to you.  I once had a chiropractor that used less than ideal billing practices that clients were unhappy with.  It is difficult to actually find out things like that right from the beginning.  I actually have gone in as a client to a few different chiropractors and got treatments from them to learn what type of work they were doing and see what their offices were like.  You can also do something like just drop into an area office and ask for a brochure or business card and say you are looking for that type of provider to refer your massage clients to.   Once you get some info and decide you would like to work with these professionals you can then begin a campaign to create relationships with them

Sometimes just starting out as a client of theirs can be enough.  But you of course can’t go to everyone out there.  Another idea is to go to places where they might be like classes or workshops or health fairs and talk to them.  There are sometimes buildings in downtown Seattle that offer small health fairs for people to go and meet practitioners.

If you are starting out blindly with a letter campaign I would suggest writing letters with the intent of referring to them first and ask about their business etc and tell them how you might need to use their services.  You can tell them what kind of clients you work with a lot.  For example a sports medicine doctor may be needed if you work with athletes.   You can tell them what your athletes do and what kind of issues they may need help with of course without naming names due to privacy issues.  Ask if they can handle that sort of patient.  Also if you are writing letters just randomly to doctors/others in your area, don’t be discouraged if they don’t reply or if nothing happens for awhile.  Send a few letters spaced out a few months apart or as you can.  Send different materials such as research studies or more proof of how massage works or case studies you have had.  If you are sending out mailings the best thing you can do really is develop a section on your website for doctors/health care providers and provide research or other insights into how massage works and what it can do.  You can make it password protected to make it seem special or just have it available for clients to read too.  You will have to be sure to write so that both can understand.

You can also take the approach a step farther and ask the practitioner/doctor if they would write a short article for your website or find out if they have something on their website that you can use.  Some websites such as Site Build it! or WordPress will allow people to post articles and then they can put a link back to their website.  You can also ask the provider for a link to your website and maybe offer an article that they can put on their website.  Trading links is part of search engine optimization.  Search engines look for how many other sites link to your site and rank your site accordingly.  It isn’t just about the possibility that someone will click through the link and you can get a direct client or at least visitor to your website – it is creating a network of sites that link to your website.

I personally have not sent any letters to physicians to try to start the networking.  I always seem to meet them in person or through someone directly.  If you were going to write a letter be sure to start it out by asking about them.  Keep it short and to the point and tell them to visit your website for more info or to call or email with questions.

After you get a referral from a doctor/health care provider the most important thing is to follow up and send a progress report even if they don’t ask for one.  More are asking for them these days from what I have experienced.  It is a great way to show them what is working for clients.  When the clients go back into their office and report back the success that is also good for marketing.  Be sure to write chart notes to follow their progress.  The best source for learning about charting is a book called Hands Heal: Communication, Documentation, and Insurance Billing for Manual Therapists
by Diana Thompson

If you have a good letter that you have used to successfully contact doctors/health care providers please share in the comments!  Or if you have any other tips and tricks for networking with health care providers.