Submit a Referral

To request music therapy services for yourself or someone else, please click here to complete our brief electronic referral form.

If you need assistance with the electronic form, please contact our office for and our team can collect a verbal intake or you may wish to print the form, complete it by hand, and return it to our office via email or postal mail.

Next Steps: Once the referral is received, our office will reach out to discuss available services and the next steps in getting started.

Note: All information provided in this form will be kept confidential and will be used for the purpose of service coordination only. This form is created through IntakeQ, a HIPAA compliant, web-based client management system used by our team to streamline our service delivery and coordination.