FORMS AND PAPERWORK - PIEDMONT MUSIC THERAPY CLINIC & STUDIO

Music Therapy CLIENT INTAKE FORMS

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

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

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

CONSENT TO EXCHANGE INFO IF PRINTER UNAVAILABLE

Audio/Visual Release
File Size:	48 kb
File Type:	pdf

Audio/Visual Consent if printer unavailable

Telehealth Consent
File Size:	83 kb
File Type:	pdf

Telehealth Consent if printer unavailable

Permission To Leave
File Size:	87 kb
File Type:	pdf

Private Practice & Studio POLICIES

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

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

Music Lessons

New Student Questionnaire

Photo Release
File Size:	79 kb
File Type:	pdf

Summer Camps

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

Main Location

SECONDARY LOCATION

READY TO DISCUSS INTAKE PROCESS?

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

Contact Us