Music Therapy Referral Form - Upstate Music Therapy Center 2026

1. Click ‘Get Form’ to open the Music Therapy Referral Form in our editor.
2. Begin by entering the child's name and date of birth in the designated fields at the top of the form.
3. Fill in the referral date and specify any disabilities that apply to the child in the provided section.
4. Indicate the name of the center-based program, along with contact details including phone number for easy communication.
5. Complete the parent information section, ensuring all phone numbers (home, work, cell) are accurate for follow-up.
6. List both primary and secondary areas of need for the child/student clearly in their respective sections.
7. Document any therapies currently being received by the child/student to provide a comprehensive overview.
8. Detail any physical or behavioral limitations that may affect evaluation, ensuring thoroughness for assessment purposes.
9. Describe modes of communication used by the child, which will aid therapists in understanding their needs better.
10. Note significant responses observed during music interactions to inform therapy approaches effectively.
11. Include contact information for a scheduling person or teacher to facilitate coordination for evaluations.
12. Remember to attach the most recent IEP before submitting. Once completed, return it to Amy Thomas, LCAT, MT-BC - Director.

Start using our platform today to fill out your Music Therapy Referral Form easily and efficiently!