MichMusic Personal Study Questionairre
Answers marked with a * are required.
ABOUT YOU
  To get started with MichMusic Personal Study, answer the questions below, then click "Next Page" until you complete the questionnaire. (It will take about 15 minutes.) We want to get to know the WHOLE you! Just skip any questions you’d rather not answer at this time; there are only a few that are required. Pricing info at the end.
 
1. Name *
 
 
 
2. Nickname or name you prefer to be called
 
 
 
3. Primary Phone *
 
 
 
4. Alternate Phone
 
 
 
5. Email Address *
 
 
 
6. Address *
Address
City
State
ZIP
Country
 
 
 
7. Age





       		 
 
 
8. Marital Status




       		 
 
 
9. Living Situation



       		 
 
 
10. Pets



       		 
 
 
11. Do you have any disabilities that would affect us in sessions?
 
 
 
12. What do you do for a living?
 
 
 
13. What if any other language(s) do you speak?
 
 
 
14. What are your favorite things to drink? (For example, coffee, tea, plain water, carbonated water, juice, soft drinks, wine, beer.)
 
 
 
15. Name a couple of your favorite snacks. (Such as fruit, cheese and crackers, chips)
 
 
 
16. Use a word or two to describe yourself. (For example, extroverted, quiet/shy, studious, adventurous, playful, and so on.)
 
 
     
 
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