PRIVATE COACHING

INTAKE FORM

Please complete the form below to let me know a bit about your interests, singing and/or musical history and any medical issues related to your vocal health. This will help me to tailor your coaching sessions specifically to you.

Include only what you wish to share. All information collected will be kept confidential.

GENERAL INFORMATION

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Age

Anyone can be trained to sing, from children to seniors. However, specific needs may vary depending on vocal development. Knowing your age category can help to determine the best approach.

How did you hear about us?

GOALS AND INTERESTS

Issues, Problems or Goals

Type(s) of Music / Artists You Like

PREVIOUS STUDY

Where / With Whom

When / How Long

Main Points Covered

Type(s) of Music Sung or Worked On

Other Singing / Performance Experience

Please provide a summary of other related experience.

VOCAL HEALTH

Previous or Current Vocal Health Issues

Family Vocal History

General Physical Health

Medications

Some medications can cause drying of the vocal folds and other side-effects that impact vocal function. Once again, only disclose medical information if you feel comfortable doing so.

QUESTIONS / COMMENTS

Anything we missed?

Use this space for any other questions you have or information you'd like to share.

TERMS AND CONDITIONS

Private Coaching Terms and Conditions

By checking this box, you confirm that you have read and agree to the Private Coaching Terms and Conditions.

Private Coaching Terms and Conditions.

I have read and agree to the Private Coaching Terms and Conditions

PRIVATE COACHING

INTAKE FORM

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