New Client Inquiry Form

Client's full name

Client's date of birth

Month

Day

Year

Caregiver's name (If submitting for a minor)

Client and/or Caregiver's Email

Phone

Preferred method of communication

Email

Phone

Purpose for reaching out

I am interested in scheduling Music Therapy sessions

I would like to learn more about Music Therapy

I am a current or former client and need to contact my therapist

Other

Tell us more about the client/yourself!

Once we receive your inquiry, Our Administrative Director (Anissa) will contact you as soon as possible.

I understand