Schedule a ConsulTATion

Know that you are not alone, and we’re here to help you on your music wellness journey.

Consultation Questionnaire

Fill out the questionnaire to schedule a consultation. All other inquiries can submit a Contact Form near the bottom of the page. Please note the only way to schedule a consultation is by filling out the questionnaire.

Prefix

First Name *

Last Name *

Preferred Email Address *

Preferred Phone *

Date of Birth *

Your Age0 / 3

Right or Left Handed?RightLeft

Street Address

Apartment, suite, etc

City *

State/Province

ZIP / Postal Code *

Country *

Your Primary Instrument? *

Current or Most Recent Job? *

If performing is not your primary job, do you play in any group(s)? if so, please list below.

At what age did you begin playing your instrument?

Do you play any secondary instruments? If yes, what and do you continue to play them?

Rate your ability to play by ear (0-10)

How long have you been experiencing performance difficulties? At what age?

Describe the nature of your performance difficulties, including what you felt was the onset and progression. Please be VERY detailed *

Do you experience any pain while playing your instrument? Describe

Describe everything you have done to remedy the performance difficulty, including work with other teachers/practitioners if applicable. Again, please be VERY detailed. *

Describe, in as much detail as you can, your musical training. (Include all studio teachers and methodology). *

Have you experimented with equipment changes?

Was there a specific event that occurred around the time of your performance difficulties?

Have you seen a doctor about the difficulty that you are experiencing?

Have you been diagnosed with Musician's Dystonia, an injury, or anything else regarding your playing difficulties? If so, when and by whom?

Are there other medical issues or medications that may be pertinent that you are willing to share? (All information is strictly confidential).

Describe yourself, including temperament, work ethic, long term goals, etc.

Would you describe yourself as a visual, auditory, or kinesthetic learner?Give percentages.

Visual Learner

Auditory Learner

Kinesthetic Learner

Total PercentageTotal Should = 100

Please fix the error above. *Acknowledge more / less than 100%

Are you athletic? If so, what sports have you participated in?

Is there anything else you wish to share today, or that we should be aware of? Anything you share will be kept strictly confidential.

How did you hear about us?

Contact Form

For general inquiries only. Do not use this contact form to schedule or ask for a consultation, please. Thank you!

Musician’s Wellness is led by Jan Kagarice, who developed her methodology through more than 40 years of research and experience coaching musicians into the highest levels of artistry

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