PIEDMONT MUSIC THERAPY CLINIC & STUDIO
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Forms


Music Therapy CLIENT INTAKE FORMS

INTAKE: MINOR
INTAKE: ADULT SELF
Intake: Adult-Guardian/POA
Remote Participation Survey

MT Consents

Consent To Exchange Info: Client Minor
File Size: 49 kb
File Type: pdf
Download File

Consent To Exchange Info: Client Adult-Self
File Size: 49 kb
File Type: pdf
Download File


Consent To Exchange Info: Client Adult-Guardian/POA
File Size: 49 kb
File Type: pdf
Download File

CONSENT TO EXCHANGE INFO IF PRINTER UNAVAILABLE
Audio/Visual Release
File Size: 48 kb
File Type: pdf
Download File

Audio/Visual Consent if printer unavailable

Telehealth Consent
File Size: 83 kb
File Type: pdf
Download File

Telehealth Consent if printer unavailable
Permission To Leave
File Size: 87 kb
File Type: pdf
Download File


Private Practice & Studio POLICIES

PMT Financial Responsibility Policy
File Size: 59 kb
File Type: pdf
Download File

PMT Treatment Policy
File Size: 75 kb
File Type: pdf
Download File


Music Lessons

New Student Questionnaire
Photo Release
File Size: 79 kb
File Type: pdf
Download File


Summer Camps

Permission To Leave-Summer Camp
File Size: 87 kb
File Type: pdf
Download File

Main Location

SECONDARY LOCATION

Picture
READY TO DISCUSS INTAKE PROCESS?
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Call 803-206-2044.

What Our Clients Are Saying

"Thank you so much for the work you do year round! You spread so much joy throughout our facility!"
~ Staff Member 

"Melissa's visits are the highlights of my mother's week: her enthusiasm is infectious and she manages to get my mother singing, and more importantly, smiling."
~Daughter of an Adult Client receiving music therapy


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  • About
  • Music Therapy FAQ
  • Lessons & Performance
  • SUMMER CAMPS
  • Forms
  • Staff
  • Contracts
  • Partners
  • Blog
  • Contact
  • Continuing Ed
  • MT Coaching
  • ASC Info
  • Internship
  • Newsletters
  • ACYC