Music For Life Enhancement Interest Form

Music For Life Enhancement Interest Form
Name*

First NameLast Name
Age*
Email*
example@example.com
Phone Number
Please enter a valid phone number.
In this unique approach we will be combining music goals and therapeutic goals to enhance life satisfaction. What are some goals and hopes you have for our sessions together?*
What type of musical experience do you have if any?*
What musical preferences do you have? (Favorite types of music, songs/styles you'd like to learn, etc.)*
What instrument(s) will you be using for our sessions?*

PianoGuitarUkuleleFluteVoiceUnsure
Would you like to schedule a free 15 minute phone consultation before scheduling our first session?*
If you selected "yes" please list some days/times you have available for our phone consultation:
Do you have any other questions, comments, or concerns?
Thank you for completing this form! I will be contacting you through the email you have provided about next steps. I am looking forward to starting this musical journey with you!
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