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 *
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) *
Name of your studio
How long have you been dancing?
What is your primary style of dance?
Are you en pointe?
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If yes, how many years have you been en pointe?
Are you in need of new pointe shoes?
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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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