DIAGNOSTIC FORM
ACTOR THERAPY 1 (NEWBIES)

Hey there, you Newbie. Please fill out the form below completely so your Actor Therapy staff can better guide you on your journey through this session of AT. This form must be filled out prior to your first class. Here we go!

Once you click "SUBMIT" below, please consider your diagnostic received; you won't receive a confirmation.

Name *

Name

First Name

Last Name

Preferred pronouns (She/Her, He/Him, They/Them):

Email Address *

Website

http://

Instagram

Twitter

Where are you from originally? *

Live in NYC now? If not, describe your living situation/commute.

Age (Put a range if you wish, but this is useful for us)

Education (incl. Degrees or Training)

AEA Status

Select one.

Representation

Check all that apply.

Agent

Manager

Where did you hear about us? *

Check all that apply.

Lindsay/RSO's Social Media

Actor Therapy's Social Media

An ad on Social Media

A sale

A friend told me

Google search

I'd been hearing about it and thought I should try it

OKAY, TELL US MORE

On average within the last year, how many times PER MONTH are you auditioning? *

Describe your work ethic.

Select one. (Be honest with yourself, lol.)

Describe your employment situation.

Check all that apply.

Unemployed (I have financial assistance)

Unemployed (I am looking for a job)

Employed: my job is flexible (I can take time off for contracts or change my schedule for auditions)

Employed: my job is lucrative (I make good money)

Employed: my job is stimulating (It doesn't make me want to kill myself)

What are some auditions you're currently preparing for?

List theaters, shows, and roles; is it open, ECC, EPA, appt., etc.? (If you're NOT preparing for auditions, tell us why?)

LET'S TALK ABOUT YOUR PACKAGE.

If someone had to pitch you to a casting director, how would they describe you VOCALLY? (Strong alto, legit soprano, etc.; use all the descriptors you can.)

If someone had to pitch you to a casting director, how would they describe you PHYSICALLY? (Athletic build, tall, short, curvy, bald, rocker look, etc.; use all the descriptors you can.)

If someone had to pitch you to a casting director, how would they describe you ENERGETICALLY? (Zen, quirky, bold, cold, professional, etc.; use all the descriptors you can think of.)

Now combine ALL of these three factors — what are some roles on Broadway (now, soon, or recently) you could play today? (And understudy or ensemble is a perfectly acceptable answer!)

SING AND DANCE

Do you currently study voice? If so, with whom?

How well you dance on a scale of 1-10, with 10 being "Dance Captain"?

Do you take dance class weekly? How often, what style(s), and where?

WE GET SO EMOTIONAL BABY

Are you pursuing any other training/classes currently, or recently? Briefly, how was your experience?

What do you feel continues to hold you back?

Anything else you think we should know about you, personally?

What are your goals for this session?

OPTIONAL: Would you like to share anything about how you identify that you think will be useful to us in helping you choose material that fits you best? This is the place to talk about gender, ethnicity, sexuality, etc. — whatever you feel comfortable (and we hope, excited!) sharing. This question is optional.

Emergency Contact Information: *

Name/Relationship/Contact Info:

Emergency Contact Information 2: *

Name/Relationship/Contact Info:

DIAGNOSTIC FORMACTOR THERAPY 1 (NEWBIES)

DIAGNOSTIC FORM
ACTOR THERAPY 1 (NEWBIES)