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Name

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How did you hear about Melissa Block Piano Studio? Were you referred by anyone?

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Can you/your child read music? (for piano lessons inquiries only)

Tell me about the experience you've had with piano lessons in the past (piano lessons inquiries only)

(Please give the amount of time you/your child has studied piano)

How serious about getting started with the piano? (piano lessons inquiries only)

Message/Additional comments

If interested in info for a wedding pianist, special event, or accompanist, please specify. Please give brief description.