New Student Form

NEW STUDENT FORM

* Indicates required field

Name *

First

Last

Pronouns *

Date of Birth *

Phone Number *

Email *

Address *

1) Have you taken lessons before? (If yes, how long?) *

2) What do you want to explore in lessons, and what are your expectations? *

3) How do you currently feel about your voice? *

4) What are your vocal goals? (Short & longterm) *

1) Do you have any vocal health concerns? *

2) Do you have mental health conditions, or learning difficulties you'd like to disclose? *

3) Do you suffer from allergies, acid reflux or post-nasal drip? *

4) Do you have asthma or other respiratory issues? *

5) Do you have any neck, shoulder or back issues? *

6) Do you have TMJ or jaw tension? *

7) Do you have a tongue tie or tongue tension? *

8) Do you have hypermobility? *

9) Any past injuries or surgeries? *

10) Do you have a chronic condition or illness (including reproductive health or hormonal)? *

11) Please list any current medications. *

12) How much water do you drink in a day? *

13) What is your average coffee/alcohol intake? *

14) Do you currently or have you previously smoked? (If yes, how long/often) *

15) Have you ever been to an ENT or Laryngologist? (If yes, please describe) *

16) Have you worked with a speech pathologist? (If yes, please describe) *

17) Any additional information you'd like to share? *

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