Referral Form
Thank you for taking the time to fill out our Referral Form. We are so glad you are here!
Once completed, we will review your information and reach out for an intake phone call to learn if we will be a great fit and to answer any questions you may have. We will be in touch soon!
*Please note: Due to high demand, we currently have limited availability. If we're unable to place you at this time, we will provide some options for you (e.g. waitlist or refer you to other providers).
If you have any questions about services or you have not received a placement confirmation within 1-2 months, please reach out to us at admin@alliancemusictherapy.com or call 612-584-0940.
Thank you for your referral and we look forward to connecting with you soon!
*If you are a BCBS Care Coordinator, please do not use this form and email us at admin@alliancemusictherapy.com if you are having difficulty accessing the BCBS Referral Form through the BCBS portal. Thank you.