PMT Survey: Remote Participation

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Thank for your interest in virtual offerings for temporary maintenance of music therapy sessions or music lessons. Access to technology from your home setting will be required in order for virtual appointments to occur. These questions will help our staff to best prepare for appointments with your family.

Any questions? Email: Director@piedmontmusictherapy.com or Call: 803-206-2044 Main Office with questions.

Email *

Client/Student Full Name *

Which PMT Staff is your family paired with? *

Gretchen Benner, LMSW, MT-BC

Gabby Jones, MT-BC, Neurologic Music Therapist

Melissa Reinhardt, MSEd, MT-BC

Miriam Tart, MMT, MT-BC

Ashley Tisdale, MT-BC

Required

What instruments/props do you have available at home? *

Piano/keyboard

Strings: guitar or ukulele

Percussion: shakers, drums or rhythm sticks

Reed/Mouth Instruments: kazoo, recorder

Movement Props: parachute, scarves, pom-poms

Other:

Required

MUSIC THERAPY APPOINTMENTS ONLY, please answer this question pertaining to visual aides *

I have a printer for printing visuals to be used during telehealth sessions.

I have an additional tech device (independent of video streaming device) available for showing pictures/visuals (to be emailed by MTBC to guardian prior to appointments).

Other:

Required

Who will be available during the appointment to provide physical support if needed?

Parent

Spouse

Grandparent

Sibling that is age 18 or older

Other:

I will prepare a space for virtual appointments that has minimal distractions (not near open windows or entry ways), has writing utensils available, clean of snacks/food, private for topics, etc. NOTE: headphones are best if possible for hearing therapist/instructor *

Yes

Required

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