Helpful Harmonies Information Sheet
Hello!

Thank you for your interest in Helpful Harmonies Music Therapy! Please fill out the form below so that we can best serve you and your family!

After completing the form, an automated email will be sent to the email address provided with next steps, so please make sure your email address is correct. Also, the email may send to your spam folder. If you have not received an email within 5 minutes after submitting this form, please check your spam folder and look for an email labeled "Music Therapy Waitlist". 

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Email *
Parent/Caregiver Name *
Phone *
City of Residence *
Child's/Children's Name *
Child's/Children's Age
What were you interested in? *
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Availability (please list days and times you are available for sessions) *
Are there any diagnoses for your child(ren) you would like us to be aware of?
If you selected "other" above, please let us know what you are interested in.
After completing the form, an automated email will be sent to the email address provided with next steps, so please make sure your email address is correct. Also, the email may send to your spam folder. If you have not received an email within 5 minutes after submitting this form, please check your spam folder and look for an email labeled "Music Therapy Waitlist". 

Please check the "read" box below once you have read the above statement.
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A copy of your responses will be emailed to the address you provided.
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