Parent Questionnaire

If you are a parent seeking music therapy services for your child please click on the parent questionnaire below to download, print, and have it filled out to the best of your ability before the initial assessment or your consultation. This questionnaire will ask you basic background information, medical history, and current skill level of your child. By filling out this questionnaire you will begin the teaming approach with your music therapist to create the optimal therapeutic experience for your child.

Release of Information and Consent Form

It is important that all members of the treatment team work together. To start the teaming, a Release of Information and Consent Form must be completed by primary caregiver and a notification must be given to the other party. When appropriate, click on the form below to download, print, and complete the form to the best of your ability. Upon completion you may hand the form to Ericha Rupp at your next music therapy session or you can email to her at info@noteablemusictherapy.com.

Referral Form

At times you may be asked for a referral letter or letter of medical necessity. When this occurs please download, print, and fill out the form below. Then email the completed form to Ericha Rupp at info@noteablemusictherapy.com or hand it to her at your next music therapy appointment. If it is an urgent request, please email Ericha Rupp directly and she will respond within 24 hours.

Letter Request Form

If there are other forms that you need, please download the Letter Request Form below, fill it out and return to Ericha Rupp at your next music therapy session or email it to info@noteablemusictherapy.com. If it is an urgent request, please email Ericha Rupp directly and she will respond within 24 hours.