QUESTINNAIRE

Please describe your practical massage experience.
Name:		Country:
Name of Organaization	Duration	Your Role	Type of Massage
	(month / year) from / to /	□ masseur □ instructor	□ relaxation □ therapeutic □ others( )
	(month / year) from / to /	□ masseur □ instructor	□ relaxation □ therapeutic □ others( )
Your present Organization
Name of organization:
Total number of staff members:	( ) persons,
including ( ) persons with visually impaired
Are you visually impaired?	□Yes □No
If your answer is “Yes”, please answer the following questions.
1) Please describe your eye condition. a) □ totally blind low vision (eye sight : right eye ( ) left eye ( ) b) The cause of your visual impairment : ( )
2) Usually you use; □printed materials □Braille materials
3) For reading;	□You can read normal printed materials with your naked eye.
□You can read normal printed materials with magnifying glass/lens.
□You can read large print letters.
□You can not read printed letters.
4) Choose how you see in your daily life;	□You can ride a bicycle.
□You can walk around an unfamiliar place without a white cane.
□You need a white cane to walk.
□You can walk alone in daylight, but need a white cane at night time.