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) Are you taking any medications with side affects that may affect your voice? (hoarseness, dryness etc) *

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

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

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

11) Have you ever been to an ENT regarding your voice? (If yes, what was your concern and/or the diagnosis?) *

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