PMT New Student Questionnaire
Welcome to the studio! Information on this form will help our staff to prepare for student's first lesson and curriculum to follow. Questions as you complete it? Email: Director@piedmontmusictherapy.com or Call Main Office: 803-206-2044.
Student's First & Last Name *
Birth date *
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If applicable: Parent/Guardian's Name *
Instrument: *
Required
If applicable: School and Grade
Mailing address: *
Email address: *
Phone number: *
How did you hear about our studio? *
Diagnosis(es):
Medication that may impact lessons:
Sensory needs:
Preferred communication:
Please detail music-making in the home setting (i.e. amateur, leisure, professionally):
Please describe any involvement in church or school music programs:
What style of teaching does or does not work well for the student?
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