To request music therapy services for yourself or someone else, please complete this brief referral form. If you need assistance with the electronic form, please contact our office for and our team can collect a verbal intake or you may wish to print the form and complete it by hand. 

Once the referral is received, our office will reach out to discuss available services and the next steps in getting started.

All information provided in this form will be kept confidential and will be used for the purpose of service coordination only. This form is created through IntakeQ, a HIPAA compliant, web-based client management system used by our team to streamline our service delivery and coordination.

We look forward to learning more about how we can meet your needs through music. 

With Passion & Purpose,

Life In Harmony Music Therapy LLC