Page 1 of 1

Piano Technique Rebuild Month, intake

Section A, intake

Full Name (First Name, Last Name)

E-Mail

Timezone

Preferred platform

Preferred platform
A
B
C
D

Preferred lesson language(s)

Select one or more. We can switch languages during the lesson if useful.
Preferred lesson language(s)

Section B, your current situation

Current level, briefly (repertoire, exam level, or self-description)

Current Level

What is the main technical problem right now?

How many minutes per day can you realistically practice for the next 4 weeks?

How many minutes per day can you realistically practice for the next 4 weeks?
A
B
C
D
E
F

Any pain, injury, or medical limitation relevant to playing?

Any pain, injury, or medical limitation relevant to playing?
A
B

In one sentence, what should be measurably better after 4 weeks?

Focus Area

Focus Area

Section C, scheduling

Give 3–6 time windows for Session 1 (110 min). Include your timezone.

Preferred pace

Preferred pace
A
B

Section E, terms

I understand the bundle is valid for 28 days from Session 1, with a 7-day grace period. Unused credits expire after 35 days.

I understand the bundle is valid for 28 days from Session 1, with a 7-day grace period. Unused credits expire after 35 days.

I understand payment confirms my slot request. Scheduling is finalized by email after payment.

I understand payment confirms my slot request. Scheduling is finalized by email after payment.

I understand reschedules require at least 24 hours notice, otherwise the session credit is used.

I understand reschedules require at least 24 hours notice, otherwise the session credit is used.
After payment, I email you within 24 hours with 3 proposed times for Session 1.