Intake form

Name *

Email address *

What is your age group?

What is your musical experience level?

Please select at least one option.

Beginner

Intermediate

Advanced

What type of music do you prefer?

Please select at least one option.

Pop

Rock

Jazz

Classical

Hip-Hop

Electronic

Folk

What are your goals in joining notes d'Or?

How did you hear about us?

Please select at least one option.

Social Media

Friends

School

Community Events

Online Search

Are you interested in participating in workshops or events?

What instruments do you play?

Please select at least one option.

Piano

Guitar

Drums

Violin

Flute

Bass

Do you have any specific topics or areas of mental health that interest you?

Which service or services are you interested in?

Please select at least one option.

Musical workshops

Community concerts

interventions

Additional questions or comments

Please confirm that you are not a robot.

Notes d'Or