Referral Form

Thank you for taking the time to fill out this form if you are interested in obtaining Music Therapy with us.

Please note: We are currently experiencing a high number of new referrals and in order to accommodate and make sure we can connect with everyone, we have set up this form.  Please fill out this form with as much information as you feel comfortable sharing with us.

Once you have completed this form, we will reach out to you by email (within one week) to get you set up with services.  If we are unable to get started with you at this time, we will give you the option to either be placed on our waitlist or to be referred to another provider that we recommend in your area. Thank you for your time and in reaching out to us.