Math Doctor: Standardized Test Prep Student Registration

1
Who is filling out this form?* This field is required.
Parent/Guardian
Student
2
Name of Parent/Guardian* This field is required.
First Name
Last Name
3
Parent's Email* This field is required.The monthly invoice and key communications will be sent to this email address.
example@example.com
4
Parent's Mobile Number* This field is required.
Area Code
Phone Number
5
Name of Student* This field is required.
First and Last Name(s)
6
Student's Email* This field is required.The Google event invitation will be sent to this email address.
example@example.com
7
Student's Mobile Phone Number* This field is required.We will contact the student at this phone number in the event that he/she is late to a scheduled session.
Area Code
Phone Number
8
For which standardized test are you looking for support?* This field is required.Roughly 20 to 30 hours of 1-on-1 instruction is recommended for most students.
ACT ($80/hr)
GMAT ($85/hr)
GRE ($85/hr)
SAT ($80/hr)
SSAT ($80/hr)
Other
9
Do you have a preference on which tutor you'd like to go with?* This field is required.
Tim Chan
A Female Tutor
A Male Tutor
No Preferences
10
Have you booked a test date? If so, when is it?If you have not yet booked a date for the standardized test, please kindly leave this blank.
Date
Month
Day
Year
11
Has the student done a mock practice test before? If so, what was the score? When was it completed?* This field is required.
12
What's the target score (or requirement at your program of choice)?* This field is required.Please be realistic.
13
For in-home tutoring, this map shows the area we're comfortable travelling to.Status as of June 2024: Limited Spaces Availanle.
14
How would you like the sessions to be delivered?* This field is required.
In-Home 1-on-1 Tutoring (+$10 per visit)
Virtual 1-on-1 Tutoring
15
What day(s) and time(s) of the week works best for you?* This field is required.Please kindly include your top 2 preferred timeslots for scheduling purposes.
16
When would you like to get started?* This field is required.
Date
Month
Day
Year
17
Anything else that would be helpful for us to know? * This field is required.Do you have any questions for us?
18
How did you hear about us?* This field is required.
19
Terms of Service* This field is required.
Should be Empty: