Lesson Request — Dr. MacKenzie, D.M.A.

Are you interested in lessons? Please submit the form below to schedule a lesson time!

Student Name

First Name

Last Name

Parent Name

If applicable

Age of Student

What instrument are you interested in?

Please tell me about your availability

Which dates and times work best for you?

Does the student have their own instrument?

if so, please tell me about it (brand, condition, ect)

Anything else I should know?

How did you hear about me?