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

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
  • Contact
  • Partners
  • Continuing Ed
  • ASC Info
  • Blog
  • Newsletters
  • Internship