Referral Form

If you would like to refer a child, adult or yourself, for music therapy sessions, please complete the referral form below. If you have questions prior to making a referral, need assistance filling out the form, or wish to request a paper copy, you can contact us on info@rmtc.org.nz or 09 360 0889. Once the referral form has been received and processed, we will be in touch to schedule a consultation meeting with you which is approximately 45 minutes long. In this meeting we will gather background information and discuss options for music therapy. Consultation meetings can be held online, and there is no charge for the meeting.  

This referral form can be completed by yourself, it does not need to be filled in by a medical professional.

Please note that all items marked * must be completed.