New Student Intake Form Name(required) Address(required) Email(required) Phone(required) How do you prefer to be contacted? Phone Email Would you like to receive the studio's e-newsletter (3-4 times per year) and periodic announcements of special Alexander Technique related events in the area? Yes No How did you hear about the Alexander Technique How did you hear about the teaching studio? Referral Internet Search Other What would you like help with? Do you have any health conditions I should be aware of including any accidents, injuries or major surgeries? If yes, please list.