Client Intake Form
Please fill out this questionnaire so we can best match you to a dance specialist that will be able to fulfill your needs!
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Dancer's Name (first and last) *
Email Address *
Phone Number
Dancer's date of birth *
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Address (include city, state and country) *
Parent's Name (first and last) (If dancer is under 18)
What are you interested in? (check all that apply) *
Required
Name of your studio
How long have you been dancing?
What is your primary style of dance?
Are you en pointe?
Clear selection
If yes, how many years have you been en pointe?
Are you in need of new pointe shoes?
Clear selection
Do you have any current injuries? (please explain)
Do you have any past injuries? (please explain)
How did you hear about us? *
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