Fill out the form below to make a referral to access music therapy directly from our own centres around the UK.

**Please note that we’re currently only accepting referrals for children for our centre in Newcastle.**

"*" indicates required fields

Full name*

Email*

Phone*

Are you enquiring for yourself, or somebody else?

Are you getting in touch for yourself or on behalf of somebody else?*

I’m enquiring for myself

I’m enquiring on behalf of someone else

(If you’re getting on touch on behalf of someone else we’ll collect their details at a later date).

What's your relationship to the person being referred?*

Name of the person being referred for music therapy*

Age group (of the person being referred for music therapy)*

Under 4

5-11

12-18

Please tell us why you're enquiring

Please tell us a little about why you're enquiring about music therapy*

Include relevant details about specific needs, including any conditions that our music therapists should be aware of.

Is the condition of the person being referred for therapy terminal or critical?*

Yes

Please give details*

Although we wish we were able to meet every request, it is not possible due to the very high demand for our music therapy sessions. If your condition is terminal or critical, we will see you as soon as possible.

Further details to help us understand how we can best help you

Which music therapy centre / location would you like to come to?*

Please note that we are only accepting referrals in the areas listed below. We are unable to consider referrals outside of these locations at this current time. This is so that we can meet the needs of those who have been waiting for a while.

Newcastle upon Tyne (Wednesday – Friday 10am – 5pm)

What's your local authority?*

Please tell us which local authority you’re in so that we can understand what services are available nearest to you.

Your nearest town*

How did you hear about our music therapy?*

Apply for music therapy – form

Make a referral to access music therapy directly from us

Fill out the form below to make a referral to access music therapy directly from our own centres around the UK.

Are you enquiring for yourself, or somebody else?

Please tell us why you're enquiring

Further details to help us understand how we can best help you