Referral Form By completing this form, you give the MTAO permission to send out the details provided to our members. If you have any further questions or concerns, please feel free to contact us via email at info@musictherapyontario.com. Contact InformationName(Required) Email Address(Required) PhoneGeographical Location:(Required) If you are willing to travel, please indicated other locations here: Client InformationAre you looking for music therapy for yourself?(Required) Yes No If no, what is your relationship to the client? Client Name Client AgeDiagnosisReason for Referral(Required)What type(s) of music therapy services are you interested in? Group Individual In Person Virtual How did you find out about music therapy? Δ